How Are Providers Reimbursed by Medicare?

Medicare is a federally funded and operated health insurance program for individuals 65 and over and certain disabled individuals. Medicare consists of Part A hospital insurance (which pays for inpatient hospital care), and Part B medical insurance, which pays for outpatient care.

Electronic Submissions

• Most Medicare-approved providers submit billing claims electronically. After Medicare receives the electronic submission, the portion that is covered by Medicare is sent directly to the provider.

Paper Submissions

• A few providers still submit claims through the mail. These paper claims are submitted to the Medicare claim processing center, and the portion that Medicare is responsible for is sent to the provider.

Non-Medicare Providers

• The patient may be reimbursed directly by Medicare for services paid for from providers that do not accept Medicare. The provider must submit a Medicare claim on your behalf after you pay the bill for services.

Patient Submissions

• If a provider does not accept Medicare and does not submit a claim to Medicare, the patient may submit a claim directly to Medicare. This requires submission of Form CMS 1490s from Medicare.

Providers

• Medicare offers a search engine for locating providers that accept Medicare.