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Information for private insurance payers
You are a primary healthcare provider (PCP) who has determined that the medical services of your patient are covered under your patient’s Part B Medicare benefit.
You must review your patient’s medical record to determine if and when his or her treatment or medication is payable under Medicare Part B. You are required to report the treatment or medication as a Medicare Part B covered medical expense in your monthly return or summary report. This is so Medicare can collect payment for the service.
Your patient is entitled to Part B coverage, but there may be some services that the government does not pay. If that is the case, Medicare will not pay for any of the expenses. This is not a fault on your part. The costs that Medicare does not pay are treated as covered expenses under Part B.
This policy covers any treatment or medication that is required for a disease, injury, or condition that is eligible for Medicare Part B. Coverage for private insurance payers ends when Medicare ceases to cover the condition or the treatment for the condition.
Your Part B claims are included in your provider reimbursement under medical services not eligible for Medicare Part B. The following is an illustration of how we may calculate your reimbursement under this policy.
Understanding Medicare
Determine your monthly reimbursement based on your monthly payments to providers.
You may be able to avoid minimum monthly payments to Medicare and save money if your net practice net income in a given month is less than the federal minimum monthly payment to Medicare. Refer to our Medicare Resources Center for more information.
What must I do to ensure I am paying the correct amount?
First, review the Medicare Master Charge Manual. Look for the required minimum payments under
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