Medicare reimburses insurance providers for claims automatically according to its reimbursement rates. Generally this is done when a provider submits claims to Medicare electronically, although in some cases providers must submit paperwork by postal mail before being paid.Continue Reading
Medicare reimbursement rates are set by federal legislation. These rates determine how much a health care provider or insurance provider is eligible to receive for services provided and are applied to charges related directly to medical care.
In rare situations, patients must file a claim for reimbursement. This occurs when they receive services from a health care provider who does not have a Medicare assignment, and therefore does not have a contract with Medicare. In these instances, the provider must accept payment at approved Medicare rates, regardless of whether or not those rates match hers. When there is a discrepancy, the patient is responsible for paying the difference.
Non-participating health care providers are allowed by law to charge patients up to 15 percent more than the approved Medicare rate for a given service. It is not uncommon for some doctors to complain about treating Medicare patients for this reason. In many cases, the approved Medicare rate for a procedure or test is less than the rate hospitals and clinics charge.Learn more about Social Services