In general hospitals or clinics will file claims for services provided to you for Medicare undeviatingly, seeking Medicare reimbursement for covered expenses without any entanglements. If you receive care for services that Medicare covers but you receive a bill because the provider did not file the claim properly or the provider does not participate. The patient is on their own, which can lead to frustration.
Medicare reimbursement is the most significant source of revenue for MCOs (Managed Care Organizations) as the federal funds supports the Medicare Health Plans. Within the model there are no requirements or incentives to pay the providers at a particular level. Often their is no opportunity to maximize the reimbursement rate. Likewise, there is no quantitative effort to increase the results on the amount that Medicaid/CHIP MCOs reimburse to their providers.
What surprise the most in Medicare Reimbursement
In recent times, the low provider’s reimbursement issues have become more acute in some places. Many providers have reported reduced fee for service provider payment rates because of the limitations on the consistency of their budget. The capitation rates have been decreased, while the states get to adjust their capitation allowances to reflect such provider reimbursement cuts.
ProMed Intel Healthcare is ready, willing and able to help you maximize your Medicare Reimbursement.