1. Why don’t Insurance Companies Reveal Reimbursement Data?

Insurance companies do not release payment details until you become part of their network—for various reasons, the key reason is that—there is a constant fluctuation in the reimbursement rates, due to a few factors and mechanisms. The contracted rates will vary even between healthcare providers as the reimbursement rates may be specific to an individual provider.

2. What are the Reimbursement Rates for Private Insurance?

Reports indicate that private insurers pay as much as double the Medicare reimbursement rates—ranging between 141% and 260% of their Medicare rates. The difference amounts were even more significant for outpatient than inpatient medical services—ranging from 190% to 265% of overall Medicare rates. The insurance amount also varies with different locations and taxonomy, among many others. Here’s a glimpse into the Private insurance reimbursement rates:

3. How your Location influences you Medicare and Medicaid insurance rates?

Location is a key determining factor. The more the convenience and accessibility of your practice in locations with higher demand, the better the reimbursement rates. Consider the below list of varying reimbursement rates across locations.

4. What are the Reimbursement Rates in Different States?

Also, note that the city in which you have established your medical practice or hospital plays a significant role than the state you pick. The above table does not represent the current or future reimbursement rates but gives you a generic overview of the reimbursement rates that you can expect.

5. Medicare vs Private Insurance Reimbursement Rates—which is better?

From the patients’ point of view, there is a conundrum over whether to choose Medicare or Private insurance. According to research conducted by the Commonwealth fund, Medicare is considered better than private insurance. The bottom line of the study is that Medicare insurance outperforms private insurance plans in terms of patient access to care, the better quality of care, which drives higher Patient Satisfaction Index (PSI) and overall insurance ratings.

Though the study identifies certain pitfalls in terms of cost controls, it concludes that Medicare is comparatively available at a more affordable cost, and certainly better for Americans of over 65 years of age.

6. What are the Reimbursements for Therapy like?

The infographic below illustrates the different Reimbursement rates for different license level:

7. Final Thoughts—Medicare and Medicaid Reimbursement Rates

Health reimbursement rates vary dramatically based on several aspects—of which the key criteria include: License, your specialty, your location, and the service map for each insurance company.

Typically, a Practice / Hospital Reimbursement Rates are extremely influenced by the Physician’s license and education, among the other factors. Subsequently, it will help if you choose an ideal place— with a higher demand for that specific specialty of service.

Next, you need to choose the insurance companies that best match your requirement criteria. For instance, some companies pay comparatively lesser, yet provide you a higher number of inbound clients (For example: Medicaid), while others may present challenges with getting in-network yet pay loftier sums of healthcare reimbursement rates. It would be best to choose an ideal insurance provider that best fits your financial strategies and long-term plans.

To learn more about specific recommendations for credentialing in your state, give us a shout at +1-(833) 33-Solve / business@solvedge.com - or simply talk to our team.