Patient education financing under Medicare.
This paper traces the history of Medicare policies and practices with respect to reimbursement for preventive health care services and examines future propositions and trends for such reimbursement to hospitals and physicians. The discussion focuses on fee-for-service reimbursement under Medicare Part B (Supplementary Medical Insurance). Reimbursement under Part A (Hospital Insurance) for outpatient diabetes education is also described. The types of services and circumstances for which Medicare Part B provides reimbursement are explained. The paper describes a variety of outpatient preventive clinical and educational services that are reimbursable when ordered by a physician for diagnosis of a suspected illness or pathology or for treatment of same. The importance of the manner of claim presentation to Medicare carriers or intermediaries is emphasized. The concluding sections examine reimbursement for inpatient hospital education under Medicare Part A in light of the growing impact of the prospective pricing system's diagnosis-related groups (DRGs). The influence of the Tax Equity and Fiscal Responsibility Act on Medicare beneficiaries' enrollment in health maintenance organizations is recognized, and implications of the prospective payment system for health education practitioners are outlined.
D007357:Insurance, Physician Services; D006278:Medicare; D010353:Patient Education as Topic / Q000191:economics*; D011445:Prospective Payment System; D014481:United States