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What is a Medicare provider?
Just the essentials...
Medicare providers can offer needed medical supplies, mobility, prosthetic and orthotic devices
Prescription medication outlets are considered providers
Hospital stays, surgery, doctor and clinic visits and brief respite at nursing homes are all offered by Medicare providers
Medicare providers can offer diagnostic testing and disease screening
Qualified patients can receive physical, occupational and speech rehabilitation through Medicare providers.
Clinical psychologists and psychiatrists are considered Medicare providers
The source of any dental work, eye exams, hearing aids, alternative medicine, cosmetic surgery and anything not deemed medically necessary is not considered a Medicare provider
Many people assume that a Medicare provider is only used in reference to doctors. There are a whole host of other medical service and product companies that are also considered providers. Medicare Part A and Part B will help cover the costs of a variety of tests, supplies, procedures and medical expertise.
You may be familiar with some, but you might be surprised at the complete comprehensive benefits that are available with the entirety of possible providers.
The design and fitting of artificial limbs and braces to help support missing or weakened areas of the body are called prosthetic and orthotic medical services.
These are covered by part B Medicare when needed for patients to improve mobility and quality of life. Prosthetic and orthotic providers generally bid for the ability to offer the services to those in need. A few of the items they provide are:
Artificial arms and legs
Knee and ankle braces
Hand, knee and arm braces
Other orthotic mobility devices
Being able to move about when you are injured or disabled is important. Items like:
Tub and bed lifts
Any item used to assist those that have difficulty walking, sitting or standing for long periods of time are also included.
Many of these companies also provide hospital beds for home use for those that will be undergoing rehabilitative therapies or need longer periods of recuperation than the hospital will allow.
Prescribed medications are almost always an essential part of health maintenance in times of serious illness, or with ongoing conditions. Medicare Prescription Drug Plans use what is called a “formulary” list of drugs that separate them into price categories. These lists are set each year, but are subject to change at any time.
You will get the best price from providers by getting prescriptions from the lowest category. If a drug that is most effective is only available in a higher category an “exception” can be made to give you the lesser amount co-pay.
Durable Medical Supplies for Use At-Home
Providers of durable medical supplies for use with patients at home must confirm that the equipment will last at least three years and is medically necessary for the health of the patient. This requires orders from the attending physician. Medicare will cover the costs for medically needed items such as:
Blood sugar monitors and test strips
Continuous passive motion machine (CPM)
Infusion pumps and necessary supplies
Nebulizers and medication
Sleep apnea and Continuous Positive Airway Pressure devices and accessories (CPAP), and more
Hospital Stays, Surgery, Doctor or Clinic Visits
Any type of hospital service is covered if you have Medicare Part A.
Part B covers other medical services such as doctor and clinic visits, physician assistant visits, surgeries and other types of outpatient procedures deemed necessary by the doctor. Each separate entity and medical personnel is a provider to those with qualified Medicare coverage.
Nursing Homes and In-Home Nursing Assistance
A temporary stay at a nursing home might be necessary when you require complete care and cannot provide that with friends or family.
Medicare will NOT pay for long-term nursing care, but it will pay for brief periods of convalescence.
Other financial arrangements have to be made in cases where the patient requires complete care for the rest of their lives. Medicare will also help cover the costs of in-home nursing assistance when it is considered more beneficial than hospitalization.
Part of staying healthy and determining what might be making you feel bad is diagnostic testing. Your doctor will need to do this at times to help make a definitive diagnosis. There are many types of tests performed daily and each service is considered a provider. Tests can include:
Heart stress tests
Blood glucose tests
Biopsies, and more
The doctor can better recommend and start a course of treatment after the results of the tests are in. It is a great investment in good health.
Clinical Psychologists and Psychiatrists
There are providers in the mental health arena as well. Staying mentally fit is an essential part of living a happy and productive life at any age.
The need for a provider of psychiatric or psychological services can strike at any age, or it may simply be an ongoing condition that needs managed.
Services can include diagnosis and treatment for:
PTSD, and more
Physical and Occupational Rehabilitative Services
There can be a number of reasons that a patient needs to have therapists who specialize in exercise that helps regain and maintain mobility.
Providers of these services must do this out of medical necessity. There are annual caps to these services. As of 2017, the limit is $1,980. If it can be proven to be medically necessary and reasonable to provide additional services it is then limited to an annual amount of $3,700 as of year 2017.
Physical and occupational rehabilitation might be needed in cases of:
Serious body trauma (such as a serious vehicle wreck)
A speech pathologist offers services to help improve speech abilities after events like:
Head or neck Trauma
Medicare will help cover the costs if it is a medical necessity but it is lumped in with physical rehabilitation. If both are required there is a $1,980 limit for a calendar year and $3,700 annual cap if an extension of services is granted.
Health Screening Services
Treating illness is much more successful when problems are caught early. This is especially true in cases involving cancer and the heart.
Health professionals that offer screening services for Medicare recipients are considered providers and will be compensated for most types of testing.
What Medical Service or Product Outlets Would NOT Be Considered a Provider?
Providing a viable service or product that will be covered by Part A or Part B Medicare requires that the attending physician declare it as medically necessary for the health and well-being of the patient.
There are additional items, services and options out there that might truly help, but if the doctor and Medicare say it is not necessary, it will not be covered. A few of the more common things not covered as provider care are:
Eye exams for glasses
Most types of dental services
Dentures and partials
Cosmetic surgery of any type
Acupuncture and other alternative medical services
Hearing aids and exams
Any medical supply, device, treatment, or drug that is NOT deemed medically necessary
It takes time and a little research to learn what Medicare Part A and Part B will and will not cover, but it is a fairly comprehensive health benefit that can help in keeping you on the road to wellness.
The most important thing to remember is that you need the backing of your doctor to make things happen.
Building a lasting and trusting relationship with your healthcare team will ensure you have help in maximizing your Medicare benefits through a network of strong and caring providers.
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