Medicare Reimbursement Fundamentals

Consult this practice note for a comprehensive discussion regarding the payment of patient healthcare expenses to providers under the Medicare program. Learn about healthcare expenses reimbursement under Medicare Parts A and B and under optional Medicare supplemental policies. Differentiate reimbursement processes for inpatient and outpatient services, health maintenance organizations (HMOs) and competitive medical plans, and specific services like renal care and diagnostic imaging.

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Related Content

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  Review the processes for appealing Medicare Part A and Part B Fee-for-Service claims denials and cost report determinations in this practice note from Geoffrey M. Raux of Foley & Lardner LLP. Refer to this resource for guidance on how administrative appeals pursued by medical providers, suppliers, and beneficiaries concerning participation in the Medicare program, or reimbursement by the Centers for Medicare & Medicaid Services (CMS), can come in a variety of settings, each with a related but sometimes different process.
• Medicare Supplemental Insurance State Law Survey
  Compare state laws regulating Medicare supplemental insurance, also referred to as Medigap, offered by private insurance companies to supplement Medicare coverage and pay for costs that Medicare does not cover. Rely on this survey to identify state laws that expand the federal open enrollment period, offer plans to persons under 65 years old, and impose penalties for violations of Medicare supplemental insurance laws.
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  Understand and advise your healthcare provider clients on the financial risks they take on when entering into risk contracts with managed care organizations. Notably, learn about how risk contacts can potentially trigger Medicare fraud and abuse concerns through use of incentives and controls, which could implicate reimbursement in exchange for referrals.

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