![]() Why Does Medicare Use Reimbursement Rates? With clinical nurse specialists that responsibility would be 15 percent and 25 percent for clinical social workers. The majority of enrollee responsibility will be 20 percent, often referred to as coinsurance. ![]() Today, Medicare enrollees who use the services of participating health care professionals will be responsible for the portion of a billing claim not paid by Medicare. ![]() The original objective was to establish a uniform payment system to minimize disparities between varying usual, customary, and reasonable costs. When Medicare was enacted in 1965, medical professionals were paid according to their charges and the enrollees were billed for the entire outstanding balances. Clinical nurse specialists are paid 85 percent for most of their billed services and clinical social workers are paid 75 percent for their billed services. Some medical providers are reimbursed at different rates. The Medicare reimbursement rates for traditional medical procedures and services are mostly established at 80 percent of the cost for services provided. While non-participating professionals and companies are able to submit claims and receive reimbursements for their services, their reimbursements will be slightly lower than the rates paid to participants. To receive reimbursement payments at the current rates established by Medicare, health care professionals and service companies need to be participants in the Medicare program. The reimbursement rates are the monetary amounts that Medicare pays to health care providers, hospitals, laboratories, and medical equipment companies for performing certain services and providing medical supplies for individuals enrolled in Medicare insurance. ![]()
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