The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Medicare Participating Providers”

Don’t Accept a Provider That Doesn’t Accept Medicare: No Exceptions

Medicare home health representativeI received an e-mail from my cousin Michelle about one of her clients, who had a very uncomfortable experience with a Medicare provider. According to Michelle, her 85-year-old client, Bill, had just undergone some surgery and was now recovering at home. He received an unwelcome – and surprise – visit from a woman who said she was from a home healthcare agency.

The woman told the man that she was sent by the hospital, and that her agency worked with Medicare. She also told him that he had to sign some papers authorizing the agency to provide his home health services.

“My client did not know anything about this woman or her agency, and the woman was very rude to him when he questioned her,” Michelle wrote to me. “He refused to the sign the documents. Was that the right thing to do?”

I had a lot of concerns about this scenario, so I immediately replied to Michelle. Here is a summary of my email to her:

• It was definitely Bill’s right to question the woman, especially since he didn’t know anything about her or her company.
• He was also right to refuse to sign any paperwork.
• Bill should contact the hospital or his doctor to confirm that the hospital had in fact contracted with the woman’s agency to provide home health care. If so, he should let the hospital or doctor know that he is not pleased that this decision was made without his consent or knowledge.
• Bill should tell the hospital or physician that the woman who came to his home was very rude, and that he would not be comfortable receiving services from this agency.
• Finally, should Bill decide to use this agency for home health services, he must first confirm that the agency is a Medicare participating provider – or in other words, accepts Medicare assignment. Just because the woman said her agency works with Medicare doesn’t automatically mean the agency is a Medicare participating provider.

What is a Medicare Participating Provider – and Why is it Important?
Participating providers have signed an agreement to accept assignment for all Medicare-covered services. In simpler terms, it means they agree to accept the Medicare-approved amount as payment in full, and will not charge patients any more than the approved amount. They also agree to charge you only the Medicare deductible (if applicable) and coinsurance amount.

Non-participating providers, on the other hand, can charge you up to 15 percent more than the Medicare-approved amount. They can also request that you pay the full cost up front at the time of service, which means you will have to wait for Medicare to reimburse you.

Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Medicare offers a search tool on its website that I suggest you use each time you see a new doctor, or, like in Bill’s case, a strange woman comes to your door and wants you to sign some papers.


Post Navigation

%d bloggers like this: