Reimbursement Terminology

Reimbursement in the context of Medicare means the payment for the inevitable expenses by the physician or the health care personnel. It can also be money paid for the duty or the work that the physician rendered. This can be applied to a health care professional or to a client/ patient in the situation that the money paid for a particular procedure is too much or the patient has insurance. Advanced Beneficiary Notice or is an announcement which is printed and is a hard copy given to the concerned individual before undergoing treatment, procedures as well as other health care services.

It informs the individual that Medicare might not pay the services being done for him or her and or the client/ patient may be the one to pay the full amount of services done for him if the Insurance company or Medicare won’t cover it. Advanced Beneficiary Notice shields people from being financially injured especially when Medicare won’t take responsibility of the procedure done. However, this also helps an individual request Medicare for a consideration.

The procedures that requires Advanced Beneficiary Notice are those treatments, interventions and procedures that patient needs in order to know what is his real health status, disorder and illness. Procedures may include, major operations inline with the diagnosis like chemotherapy, abdominoplasty, Mastectomy, hip replacement,, hysterectomy, TAHBSO, cranial surgery, blood banking and others. However, there are procedures that Medicare doesn’t cover even if the doctors find it very necessary that the patient should undergo then this is where reimbursement and ABN most useful.