Medicare Reimbursement

The federal government is the largest payer of healthcare services in America. The way Medicare reimburses hospitals or providers can be used as a benchmark to test a medical bill.

The difficult task is trying to understand or figure out how Medicare reimbursement works. Over the years Medicare has implemented a very complex set of rules and regulations. Medicare got its start in 1966; in the beginning Medicare mainly reimbursed providers based on their cost of caring for the Medicare patient. In 1983 Medicare radically changed the method of paying for the care of inpatients in an acute care hospital. Medicare started the Prospective Payment System. The PPS systems began grouping patients into Diagnostic Related Groups or DRG’s, patients with similar procedures and care were paid a set amount for the hospital. Medicare started out with about 400 DRG groups, since that time the DRG groups have expanded to over 1,000. In order for you to calculate how your service or procedure would be reimbursed from Medicare the process can get complicated.

On June 1, 2006 the United States Department of Health & Human Services issued a press release entitled “Medicare Posts Hospital Payment Information”. In this press release it was stated that this is an important step toward transparency in health care cost. The following is an excerpt “To help consumers, providers and payers make more informed health care decisions, the Department of Health and Human Services through its Centers for Medicare & Medicaid Services(CMS) today posted information on what Medicare pays for 30 common elective procedures and other hospital admissions. President Bush directed the data be made publicly available to all Americans as part of the Administration’s commitment to make healthcare more affordable and accessible”.

The problem with the above release of information was that it was by county and for only 30 different procedures. Our company has the resources and the knowledge to get the information you are looking for on your medical bills. If you want to know what Medicare would reimburse for your hospital bill or your physician bill, let us fight through the confusion and get you that information.

We have the information for every procedure by every hospital.

Contact us at (512)852-8265 or (800)906-8085.

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