MEDICAL BILLING AND CODING

Friday, October 3, 2008

MEDICARE

Medicare is a federal government health insurance program which pays for certain healthcare services and originated from a federal law, title XVIII of the Social Security Act.
Medicare is health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney failure. The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long term care

Medicare is managed by Centers for Medicare and Medicaid Services (CMS), which covers nearly 40 million Americans and provides coverage for:
 People age 65 or older,
 Some people under age 65 with disabilities,
People with End-Stage Renal Disease (ESRD),
which is permanent kidney failure requiring dialysis
or a kidney transplant.

PART A
Hospital insurance plan financed mostly through taxes on employers and employees. Persons who qualify for Medicare receive Part A automatically. A beneficiary or beneficiary’s spouse must have paid Social Security Taxes or premiums for at least 10 years/40 quarters.

PART B
Supplementary medical insurance that pays for physician services and other services not covered under Part A. persons who qualify for Medicare do not automatically receive Part B. These individuals must purchase Part B.

Medicare Part A:
Part A of the Medicare Program is for inpatient services and hospitals submit Medicare claims to Part A intermediary. Part A benefits include: Hospital stays, Skilled nursing facility, Home health care, Hospice care, or care in a psychiatric hospital.
Medicare Part B:
Part B of the Medicare Program is for professional/physician services. This coverage helps pay for medical and surgical services by physicians as well as certain other health benefits such as ambulance transportation, durable medical equipment, outpatient hospital services, and independent laboratory services.

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