Medicare is a federally managed insurance plan provided under the Social Security Administration and is provided to many individuals that are retired or disabled.
Quality of Care
The quality of care provided by hospitals and providers may decrease as a result of being encouraged to pursue less expensive treatment options, even if it is not the best option, in order to decrease the likelihood of having a claim rejected by Medicare.
Reimbursement Rates
Many physicians choose not to accept Medicare or limit the amount of Medicare patients due to low reimbursement rates compared to private insurance companies.
Paperwork
Excessive amounts of regulations and paperwork must be complied with and completed in order to ensure payment from Medicare for services and also to avoid repayments. This is a major deterrent for private practices, since the administrative cost to handle Medicare claims is not affordable for some providers.
Audits
Medicare audits are common and attorney fees and other legal costs for defending against fraud claims is very expensive.
Staff
Additional staff must be hired in order to help ensure compliance with Medicare regulations. Accountants, attorneys and additional billing staff are frequently required.
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