Medicare Compliance & Reimbursement

Let's face it: Medicare is so complicated we sometimes feel that both our patients and we need PhDs to figure it out. Now you can move to the head of the class with these answers to your patients' most common Medicare questions.

A. If a provider accepts assignment, that means it agrees to accept the Medicare payment amount for a particular item or service as its payment in full. But the patient must still pay the copayment, plus any applicable deductible.

A. In that case, the patient may have to pay more than the Medicare amount, although for most services a doctor's office can only charge up to 15 percent more than the amount Medicare usually pays. It also means that the patient may have to pay for the treatment's full cost up-front. Then the practice will bill Medicare and send the Medicare payment to the patient, minus any copayments or deductibles.

A. This means Medicare probably -- or definitely -- won't cover a particular service. When the patient signs this form, he agrees to undergo a particular treatment whether or not Medicare covers it. If Medicare won't cover it, the patient agrees to pay for it out of pocket.

A. If the patient is concerned about being able to afford all the payments that Medicare leaves her liable for, explain that there are other programs that may help. If the patient qualifies for Medicaid, it may cover some of the payments that Medicare won't handle. The patient can also buy Medigap insurance to "fill the gaps" in Medicare coverage. Some states also offer the Program for All-inclusive Care for the Elderly (PACE), which covers all services for frail elderly people.

Tip: Online answers for you and your Medicare benes: Go to http://www.medicare.gov, and check out Medicare and You 2008, available in both English and Spanish.