A Medicare refund schedule is the amount a doctor or medical facility will receive for a particular procedure in the United States when treating a patient covered by the Medicare program. This money is set by the US government and can be changed based on a variety of factors. Medicare installment plans are generally less than doctors will receive if a patient has private insurance or pays in person for the procedure. Some in the medical world have criticized the lower payments and because of this, the problem is often politicized.
The fee schedule is determined by the doctor’s Payment Review Commission, which recommends the plan to Congress. Under the previous system, Medicare payments were determined by a reasonable fee policy that led to major differences between healthcare providers. Congress has the last word in any timetable and can potentially be influenced by constituent groups. The fee schedule is based on the relative cost of the procedure, the area, and other parts of a formula may include such provisions as a 10 percent incentive for those providers who practice in areas that have critical shortcomings.
If a hospital, private doctor or other type of medical facility accepts Medicare patients, they must also accept the Medicare refund schedule. Those who try to increase revenue by requiring some co-pay from the individual are in violation of the law if the co-pay extends beyond the maximum allowable timetable. While these payments may not be as much as they can get from other sources, healthcare providers may be more willing to accept patients because of the large number of people using Medicare. The economies of scale can still allow facilities to turn a profit.
Factors for medicare
One of the key factors for the Medicare refund schedule is geographic location. Some procedures may receive higher payments in some areas due to factors such as service delivery costs. If the doctor’s costs are lower, then doctors in these areas can get a lower payment. Some doctors feel that this is a form of geographical discrimination where the states with higher populations, and thus more influence in Washington, DC, gain more benefits for certain constituent groups. Others claim the practice helps keep costs down and provides a reasonable payment for everyone based on cost.
Medicare installment plan
The Medicare installment plan outlines payments that the federal government will pay directly, and payments that the patient is responsible for paying. For example, if Medicare will pay 80 percent of a particular procedure, then the patient is responsible for the rest. This is one of the only legal times that the Medicare patient can be billed. One of the other major exceptions is when the procedure is done, not covered by the Medicare refund schedule.