Question

Introduction to Healthcare Insurance Coding, Billing, and Reimbursement

Medicare and Medicaid are federal programs that cover a large proportion of the US population with healthcare. The two have similar objectives in the area of providing care, but there are significant differences in them that concern reimbursement.

Tasks:

Describe each program, Medicare and Medicaid.

Provide the major features of each program.

Discuss how these programs differ from each other.

Briefly describe the process of how to bill for each program.

Answer 1

Medicare and Medicaid are the programs which mainly concerns with the healthcare of people.

Medicare: It is a federal health program, or kind of insurance for the elderly people who are above 65 years, those people who have some physical disabilities etc. This medicare is divided into many sub categories Part A, Part B, Part C and Part D.

The Part A consist of the healthcare and hospital staying charges as well as the care under well skilled nurse.

Part B includes the doctor's service and outpatient care

Part C involves a kind of medical care advantages and it is provided by private companies those have collaborated with medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits.Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations. Private Fee-for-Service Plans, Special Needs Plans, Medicare Medical Savings Account Plans.

Part D, it covers mostly prescription drug coverage such as some Medicare Cost Plans and some Medicare Private-Fee-for-Service Plans.

Medicaid: It is program which administered by states,according to federal requirements. It provides healthcare coverage to millions of people. The programs includes help for the lower income of people for the medical cost. But other benifits like medicare, nursing home care and personal health service cannot be obtained.