What Are the Medicare Reimbursement Guidelines?


Quick Answer

Medicare reimbursements operate on a fee-for-service model that is based on the type of procedure, as the U.S. Department of Health and Human Services claims. This system is transitioning into one based on quality over procedure quantity. Providers usually receive reimbursements directly, and coverage of specific services depends on where the patient lives.

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Full Answer

Medicare reimburses providers directly for most products and services, as reported by HHS. The exact coverage of procedures and products depends on where the patient lives, and patients should consult the Medicare website for lists of approved procedures and medical products. Medicare typically does not reimburse patients directly for out-of-pocket costs, and program eligibility differs tremendously for different patients. Medicare has the final say about which items are covered and how much of the financial cost is reimbursed.

Health care providers have the option of refusing to accept Medicare reimbursement. These providers may refuse to offer services to Medicare patients, and reimbursement is not available for services from these providers. Medicare reimbursement is currently undergoing changes as of 2015 to encourage improved service quality, according to HHS. Consumers should seek the latest information from Medicare directly and visit the Medicare website for reimbursement forms. Claims for Medicare reimbursement may be filed by visiting the Medicare website or through the mail.

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