During an inpatient hospital stay, a surgeon performs an operation on a Medicare beneficiary. How are the surgeon's professional fees billed under Original Medicare?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Medicare Part A covers inpatient hospital services, but it does not cover the professional fees of physicians, surgeons, and other providers who treat the patient during the stay. Those professional services are billed under Medicare Part B, which is the medical insurance component covering physician and outpatient services. The hospital bill under Part A covers room, nursing, equipment, and hospital services, while the surgeon's fee follows the Part B path with its own deductible and coinsurance. This split between facility services and physician services is a classic and frequently tested Medicare point.
Why the other options are wrong
- B) Part A pays the hospital for the facility and its services; it expressly excludes physician and surgeon professional fees.
- C) Uncompensated care funds are hospital charity programs, not a Medicare billing mechanism for a covered beneficiary's surgery.
- D) Medigap is a secondary supplement that pays cost-sharing after Medicare makes its payment; it never acts as the primary payer.
Memory hook
The facility is Part A's bill, but the surgeon's fee is always Part B's business.