Medicare Intermediaries Home Care Path

An Intermediary is an organization that has entered into an agreement with HCFA the Health Care Finance Administration to process Medicare claims. The money flows from the U.S. Government (Health Care Finance Administration) to the intermediary, down to the provider when a claim is submitted. The intermediary contracts with Medicare certified providers to process the claims under the authority granted by the Health Care Finance Administration (HCFA).

Intermediaries make payments to the Medicare certified providers they have contracted with. Providers can include hospitals, nursing homes (SNF skilled nursing facilities), home health agencies (HHA), and end stage renal disease facilities (ESRD). The amount of payment to any provider is restricted to a resonable cost of the covered services and items.

Intermediaries are mandated to assist in the application of safeguards against unnecessary use of covered services. Covered services and equipment must be deemed medically necessary. Intermediaries must assist the Medicare certified provider to establish and maintain the required fiscal data. Intermediaries serve as a center for communicating with Medicare certified providers. Intermediaries conduct systematic audits of provider records. Intermediaries over see the beneficiary appeal process. Intermediaries can assist providers in the process for becoming Medicare certified.

Certified Medicare providers have agreed in the contract with the intermediary not to charge the patient for items covered by the health insurance program other than allowable charges, deductibles, and coinsurance amounts. Home Care Path www.homecarepath.com staff assist seniors with organizing important papers. If Medicare is the pay source the provider cannot then charge the patient to collect more money than the Medicare intermediary has agreed to pay. This protects the patient from excessive charges.