Question

How is a doctor who agrees to take Medicare paid?

A. He or she agrees to take only what Medicare pays for the service
B. He or she is allowed to bill the patient for the difference between what Medicare pays and what he or she charges
C. He or she is paid by a third party to make up the difference between the fee-for-service rate and the fee allowed by Medicare
D. He or she can sue the government if the full fee is not paid
E. He or she is not allowed to charge copays

Answer 1

Doctors who accept Medicare are paid based on the Medicare-approved amount for their services and cannot bill patients for more than Medicare allows. Patients may have copays and deductibles within this system. Alternative payment models like HMOs involve fixed payments per patient, influencing healthcare incentives differently.

Step-by-step explanation:

A doctor who agrees to take Medicare is typically paid under Option A, which means they agree to accept the Medicare-approved amount for their services as full payment. Under this system, the doctor is reimbursed according to a fee schedule set by Medicare. While doctors may bill for a deductible and copays, they cannot charge beyond what Medicare approves. In certain instances, with Medicare Part B, the patient pays a monthly premium, deductible charges, and copayments, with the government contributing about three-fourths of the overall costs.

In a fee-for-service system, medical care providers are paid according to the services they provide. Another reimbursement model involves Health Maintenance Organizations (HMOs), which operate differently, as providers receive a fixed amount per patient enrolled, regardless of services provided. Both systems have their distinct outcome on healthcare incentives and patient costs.