Final answer:
Medicare claims are typically submitted directly by the health provider, not by the Commissioner, patient, or an arbitrator. Providers in a fee-for-service system get reimbursed based on the cost of services rendered to Medicare patients. Patients are sometimes responsible for deductibles and copayments. Option 2 is correct.
Step-by-step explanation:
To submit a Medicare claim, it is the health provider who typically submits the expenses directly to Medicare after providing services to the patient. In most cases, when a patient receives services from a Medicare-enrolled provider, the provider is responsible for submitting the claim to Medicare for payment.
This system is known as a fee-for-service health financing system, where the reimbursement to medical care providers is based on the cost of the services they provide.
Patients are usually required to pay a deductible and copayments, and there may be no limits on the total costs they can incur. In cases where patients must submit their own claims, which is rare, it involves filling out specific forms and providing the necessary documentation to Medicare.
Medicare as it was established in 1965, has since grown to cover an increasing number of beneficiaries and has evolved in its mechanisms of funding and reimbursement.
It consists of four parts: Part A for hospital insurance, Part B for medical insurance, Medicare Advantage (Part C), and the prescription drug benefit (Part D). Providers must navigate these components of Medicare and submit claims accordingly to receive reimbursement for the services they provide to enrollees of the program.