Doctors provide a service and receive payment at the time of rendering that service. For some patients, this means paying the full amount of the bill when checking out after an appointment, but for others, it may mean providing private insurance information and making a co-insurance or co-payment amount for the services provided. For Medicare recipients, however, the system may work a little bit differently.
When someone who receives Medicare benefits visits a physician’s office, they provide their Medicare information, and instead of making a payment, the bill gets sent to Medicare for reimbursement. There may be times when a patient with Medicare is responsible for a portion of the cost of the visit if it’s known that the service is not covered or the physician does not participate in a particular part of Medicare, but for the most part, the doctor’s office will work with Medicare to collect payment.
Do all doctors accept Medicare?
While a huge percentage of physicians do accept Medicare patients, not all provide full services under Medicare. In some cases, a doctor may choose to participate in Medicare insurance by providing only select services for reimbursement, while for others, the patient may be responsible for covering the cost. In order for a physician to participate in the Medicare program, he or she needs to be reviewed by Medicare and sign a contract agreeing to Medicare’s terms. This contract may also outline select services that the physician acknowledges will not be covered or will only be partially covered, and it should also detail the rates for reimbursement to the physician.
How does Medicare pay your bill?
The way that Medicare is structured, payment rates tend to be a bit lower than if a patient paid a bill in cash. The reason so many doctors accept Medicare patients, even with the lower reimbursement rate, is that they are able to expand their patient base and serve more people. If a doctor can attract and help 10 more patients per week while only losing out on a small percentage of revenue, then it makes sense to have more patients coming through the door as the additional patients more than make up for the loss.
What determines Medicare coverage?
In order to know what is and is not covered by Medicare for reimbursement, a set of guidelines is issued each year with specific codes for a large variety of services. A patient may be able to receive treatment for things not covered in these guidelines by petitioning for a waiver. This process allows Medicare to individually review a recipient’s case to determine whether an oversight has occurred or whether special circumstances allow for an exception in coverage limits.
Prescription medications may be covered under Medicare Part D. Each Part D plan will have its own formulary, or list of medications covered.
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