How do doctors collect Medicare payments?


Quick Answer

As of 2015, doctors collect Medicare payments through reimbursements. Both Medicare and Medicaid are categorized as fee-for-service programs, and in order to be reimbursed, doctors must file an insurance claim, as PBS' Frontline explains.

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Full Answer

Both private and government-run health care providers use the fee-for-service method. Physicians, hospitals and other providers set the price for specific services, and the health care service payer pays the charges without any pre-arrangement of fees made once a claim is filed. However, there are certain guidelines that must be met and maintained under the Medicare and Medicaid programs in order to reduce fraudulent filings. Prearranged discounts are still a part of fee-for-service programs, and they describe the services that doctors and hospitals have agreed to perform at a prearranged discounted rate to the payer, according to PBS' Frontline.

In 2014, Medicare released payment information regarding service rates charged by doctors in 2012. This instance was the first time Medicare had revealed this type of information since 1979, according to The Advisory Board Company. The data provided by Medicare shows that it paid $77 billion to over 880,000 health care providers under Part B alone in 2012. The report also includes doctors' names and addresses, summaries of the services provided, and the amount paid. The final analysis revealed that a small number of doctors received disproportionately large sums of money, as The Advisory Board Company reports.

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