How to Increase Medicare Reimbursements in Healthcare Organizations

Almost every hospital and healthcare organization in The United States is probably trying to figure out How to Increase Medicare Reimbursements. This is because every hospital and healthcare organization has to take part in Medicare and be a part of the system and so they have to learn how to navigate it.

What is Medicare Reimbursements

Medicare Reimbursements are the payments that hospitals and doctors receive from Medicare for the services they’ve offered to Medicare beneficiaries. The rates are already set by Medicare and cannot be changed by the hospital. The main drawback of Medicare Reimbursements is that the payments are usually lower than what the hospital will normally bill or what private insurance companies will charge. Thus some doctors and hospitals are not very keen on participating in Medicare. This thus distinguishes them from participating Providers

Participating Providers and Non-participating Providers of Medicare Reimbursements

Participating providers of Medicare as you might have already deduced, are physicians and hospitals that agree to fully accept the Medicare rates and reimbursements. This means that any services they provide that fall under the Medicare-covered services can be reimbursed. Most physicians and healthcare organizations are participating providers. Now plot twist, not all participating providers accept and agree to treat Medicare patients. So check with your hospital and doctor if you have Medicare to see if they are participating providers and if they can provide care to you in order to be reimbursed by Medicare.

As mentioned above, Medicare reimbursement rates are usually lower than private insurance reimbursements or out of pocket payments and so for this reason, some physicians choose not to participate and this makes them non-participating providers. The fact that their non-participating does not mean its cold turkey for Medicare. SOme cans till accept Medicare reimbursements for some procedures. If you have Medicare, you can seek the services of a non-participating provider and pay upfront then Medicare will reimburse you directly. In situations like this, these non-participating providers can only bill you up to 15% more than the Medicare reimbursement amount. Its less for some states.

How to Increase Medicare Reimbursements

For new and existing hospitals looking to increase their  Medicare Reimbursements, they can try to following strategies

Population Demographics

If a hospital is located in an area where most of the population uses Medicare, then they will have a higher reimbursement. A new hospital or an existing hospital looking to set up a new branch can look up the population demographics and figures of different locations to help them make their decision. If a hospital is located in a city or an area where most of the residents do not have Medicare or cannot afford it, then most of the patients they would receive would not have Medicare thus reducing their Medicare reimbursements. Thus figuring this out ahead of time will be a proactive way to ensure increased Medicare reimbursements.

Surrounding Competition

Just as the location demographics of a patient can affect Medicare reimbursements, so can the surrounding competition. A hospital located in a place where there are lots of other hospitals and thus a lot of competition will have a harder time increasing its Medicare reimbursements. This is even so if the surrounding hospitals are also participating providers. Just as this is the case, the opposite can also be the case. If a hospital notices that competing hospitals in different location have a high rate of Medicare reimbursement, then they can see that that location has a  high population of patients with Medicare thus increasing the viability of opening a branch in that location.


Visibility means both physical, online, and industry visibility. Most healthcare directories have a list of hospitals and physicians that are participating providers. Being on this list means that the healthcare organization of physician will have more eyes on them and their services and as such, have more Medicare patients coming in. The higher the visibility, the higher the Medicare reimbursements. Healthcare organizations should find ways to make themselves more visible to patients with Medicare in order to get their attention and provide services to them thus increasing their Medicare reimbursements.


A healthcare organization should have proper and efficient communication with its patients and with Medicare about payments. If there is no proper communication, so much could get lost in translation. Paperwork could get filled incorrectly leading to a loss of or a delay in payments. Lack of proper communication could also mean that some patients could be unaware of the healthcare medicare status (i.e if they are participating or non-participating) and this could also lead to a loss of revenue. Proper communication should be both vertical and horizontal within the organization. Healthcare staff should be efficient when communicating with outside payer organizations including but not limited to Medicare. When there is smooth communication, it also serves as an incentive to patients as the lack of complications with payment will keep them coming back thus increasing the healthcare organization’s Medicare reimbursements.

Conclusion on How to Increase Medicare Reimbursements

The healthcare industry in the United States is very complicated and full of so many rules, regulations, changes, loopholes and much more. It takes always being on top of things to be able to always know what’s going on when it comes to physician compensation, insurance reimbursements, Medicare and Medicaid, Obamacare, private insurance, out of pocket payers, and much more. Legislations are always changing and new rules are always emerging. Doctors and industry professionals always complain about so many rules and paperwork that comes with the job. A healthcare organization should be aware of this and put things in place to make the process easier for both physicians, nurses, hospital administration, and patients.