How to Solve Medicare Confusion

Medicare rules can confuse anyone --- even people who work for Medicare. With volumes of regulations that are updated and changed regularly, and in some cases interpreted by adjudicators and administrative law judges, it's easy to lose track. Patients, medical providers, medical billers and Medicare officials alike run into moments of confusion and must turn to their resources to resolve various situations.

Instructions

• 1

  Visit the Your Medicare section of the Medicare website. Using your Medicare ID number, you can create a login and password and then access your personal Medicare information. Your Medicare allows you to see recent billing, treatments and approvals as well as view coverage information and numerous downloadable brochures.

• 2

  Call Medicare's customer service line to clarify your benefits and coverage. If you have a specific procedure in mind and want to check if Medicare will cover the costs, Medicare customer service agents can answer your questions in detail and explain any required pre-authorizations, co-payments and provider requirements that may be involved.

• 3

  Contact your private insurance company if you are enrolled in a Medicare Advantage plan. When you enroll in an Advantage plan, you elect to have your Medicare benefits administered by a private insurance company approved by Medicare. This means that any issues on coverage, billing, authorizations and disputes run through your insurance company. Do not contact Medicare directly except to file a complaint against your Advantage provider if it becomes necessary.

• 4

  Visit the Center for Medicare and Medicaid Services website to view provider guidelines and regulations if you are a medical provider needing to understand covered services and reimbursement. Medicare has specific site areas as well as downloadable handbooks available for each area of medical practice and service including home health services, acute care hospitals, skilled nursing facilities, physical rehabilitation therapy and pharmacy.

• 5

  Call the CMS hotline for medical providers to ask clarifying questions on service eligibility guidelines, billing issues, your provider status, or regulations about the manner in which services can be provided for a patient. If you are already seeing a Medicare patient, you can discuss the case within the guidelines of the Health Information Portability and Accountability Act to seek guidance on if and how you may treat that person.