Patient Payment Methods

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Outpatient Medicare

Case # 2
Write 4-5 pages responding to the following questions:

Discuss the difference in Medicare payment methods for outpatient services and physician services.

Medicare Part B pays for outpatient services. If you are enrolled in a type of Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) the same rules apply. Medicare Part B pays for most of the testing done such as x-rays, screening exams, blood tests and hospitalization in the outpatient services and in community mental health centers. Medicare Part B using what is called the Prospective Payment System (PPS). This works by paying a set amount of money to provide definite outpatient services to people with Medicare. Once you meet the deductible, Medicare will pay most of the payment and the patient will then pay a co-payment. For certain services, a co-payment may not be necessary, such as with mammography. The PPS is an adjustable rate based on factors such as per capita income and whether the hospital is rural or urban.

As a Medicare recipient, you may be asked to pay your yearly deductible. After that, you will be asked to pay a co-payment for each service you receive as an outpatient. For each time you use the Medicare Part B, the amount cannot be more than the Part A inpatient hospital deductible. Some of the types of services provided may be splints, stitches, x-rays, casts and including Emergency Department charges. You may need a relatively simple surgery that can be done in outpatient and can be released to go home. Observation can be paid if in the hospital for a short period such as getting intravenous fluids or short term medications that you cannot give to yourself. Medicare Part B also pays for Hospice services. An example of a patient on Medicare Part B may be a person who has had a cast for eight weeks and needs to have the device removed. The local hospital charges $300.00 ...