I know that there are many different types of payers that receive payment for services. Do they all follow the same rules and policies?
No. Just as there are many different payers (e.g., Medicare, Medicaid, Worker’s Compensation, Blue Cross/ Blue Shield, School Systems, Private payers), there are different rules that each payer creates for its company. The Medicare system is the only system that creates national guidelines that apply in every state. Medicaid is federally funded but the individual states oversee its operations and therefore, the guidelines for Medicaid vary from state to state. Private payers (like Horizon, Cigna, BC/BS), create their own payment rules.
