Cost reimbursement grants are made available through federal, state, and local government agencies, businesses, and the general public. The grant process focuses on making sure the money spent on patient care is more efficiently spent. This process allows people to get involved in deciding how to spend the money through these types of grant programs. To find out more about how to apply for a grant, read the How to Apply for a Cost Reimbursement Grant article on NSHIP website.
What do the costs of cost reimbursement grants do for Medicare?
In many cases, the cost reimbursement funds for Medicare are used to reimburse doctors and hospitals for the cost of medicines, diagnostic tests, and other related expenses.
For example, when a doctor sends a patient to the emergency room because of the cost of a test or medicine, that doctor would normally qualify for reimbursement through Medicare. However, according to Medicare, the amount of the emergency room visit must be less than $50 for a doctor who is responsible for $250,000 in annual Medicare spend. So the doctor can qualify for only $45 reimbursement under the cost reimbursement program.
The government may consider other costs in deciding how to pay for a medicine or test. This can include the cost of a new prescription needed to treat the drug in question, the cost of the doctor’s travel and training expenses for visiting a new doctor, and the value of the insurance coverage the patient had during the consultation. These considerations often apply to hospitals that perform certain procedures. For example, a hospital may be reimbursed based on the doctor’s income and expenses after tax, depending on the type of outpatient surgery performed and whether the doctor has an independent practice.
What does it mean to be “covered by a reimbursement fund”?
The federal government says that a “reimbursement fund” is a nonprofit organization that is eligible to participate in Medicare and Medicaid programs, meaning that these programs pay for certain covered services for Medicare recipients. This does not mean that a doctor must have Medicare or Medicaid coverage. For example, a person who has no Medicare or Medicaid coverage may be a “covered” doctor in these programs.
As an example, say you are in a state with no insurance co-payments for hospital stays. You have no other insurance for your doctor or hospital stay. Your doctor has Medicare and Medicaid coverage but doesn’t require other insurance for your stay. And the hospital has Medicare and Medicaid coverage but requires you to meet certain standards. Both you and your doctor might