Question

What are the requirements for medicaid and medicare reimbursement?

Answer 1

Answer-

Medicaid

Medicaid is an assistance program that covers low-to-no-income families and individuals. Children are more likely eligible than adults for coverage. Under the Medicaid scheme there is strict income requirements related to the Federal Poverty Level (FPL). After expanding the Affordable Care Act, 26 states cover at or below 138 percent of the FPL.

This program covers emergency care, family planning, hospice and smoking cessation programs. It also covers dental and vision coverage to a limited extent.

Medicaid is governed by the federal and state governments. The funding is done by taxes and 57 percent comes from the federal government.

Medicaid reimbursement payment goes to the provider, however doctors who chose to be Medicaid providers are required to accept the reimbursement provided by Medicaid as payment in full for the services provided.

Medicaid does not pay money directly to individuals, but sends payments to the health care providers. The different States make these payments based on a fee-for-service agreement or through prepayment arrangements such like health organizations.

Medicare

Medicare is an insurance program that mainly covers seniors aged 65 and older and disabled individuals who qualify for Social Security. Medicare cover irrespective of income who turns 65 can enroll in this program so long as they paid into Medicare/Social Security funds.
This program also covers individuals of any age with severe disabilities and end-stage renal disease are also eligible.
Medicare to a lerger extent similar to Medicaid, covering routine and emergency care, hospice, family planning and smoking cessation programs and to a limited extent to dental and vision.

Medicare reimbursement refers to payments hospitals and doctor can receive after the services are provided to patients who are covered under Medicare.
The reimbursement is directed to the billing provider. Doctors has the choice to choose to accept the rate that Medicare has set for the services they have provided.
Medicare pays 80 percent of these costs.
Medicare funds are collected through payroll taxes through the Federal Insurance Contributions Act and the Self-Employment Contributions Act. The other funding comes from premiums, deductibles, coinsurance and copays.