Can physicians seek payment from beneficiaries when Medicare denies screening and stabilizing care as medically unnecessary?

When Medicare denies payment for screening and stabilizing care on the grounds of medical necessity, physicians are generally not allowed to seek payment from beneficiaries. Medicare has strict guidelines in place regarding beneficiaries' financial liability, particularly in the context of services deemed medically unnecessary. If a service is not covered by Medicare for any reason, including a determination of medical necessity, the beneficiary cannot be held responsible for the cost of that service.

This policy is established to protect patients from unexpected financial burdens for services that are not covered under their Medicare plan. The goal is to ensure that beneficiaries do not face additional costs for care that is not justified medically, emphasizing patient protection as a priority within Medicare's framework.

In situations where coverage denials occur, the responsibility lies primarily with Medicare and the providers must adhere to the rules set forth to prevent the inappropriate transfer of costs to patients. Therefore, it is critical for both physicians and beneficiaries to understand the implications of these coverage decisions and the resulting financial responsibilities.