Fundamentals of Medicare

Section 1: Introduction


Participating Providers

Providers receiving Medicare reimbursement are known as “participating providers.” To become a participating provider, a provider must be in compliance with applicable provisions of Title VI of the Civil Rights Act of 1964 (refer to CMS IOM, Publication 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 1, Section 20.2). 

A complete list of these provisions can be found on Justice.gov. A few of these provisions are:

  • The provider will not provide any disposition, service, financial aid, or benefit to an individual that is different, or is provided in a different manner, from that provided to others under the program.
  • The provider will not treat an individual differently from others in determining whether he/she satisfies any admission, enrollment, quota, eligibility, membership, or other requirement or condition which individuals must meet in order to be provided any disposition, service, financial aid, function or benefit provided under the program.
  • The provider will not charge any individual or other person for items and services covered by the health insurance program, other than allowable charges and deductibles and coinsurance amounts. A provider agrees that it will return any money incorrectly collected from the individual or other person on his/her behalf.
  • The provider agrees to provide Medicare beneficiaries with services ordinarily furnished by the hospital to its non-Medicare patients. A hospital may have restrictions on the types of services it provides; however, these restrictions should apply to all patients not just Medicare patients.

Reviewed 6/4/2024