Introduction to Government Insurance Programs

where are medicare funds provided from?

Federal social security act

proof of eligibility

ID card- office must need to verify because eligibility may change from month to month

Part A

covers insitutional providers for impatient, hospice & home health service

Part B

covers non-institutional health care providers for outpatient services

CHAMPVA

covers spouses or unmarried dependent children of veterans with permanent total disability or veterans that dies in the line of duty

CHAMPUS eligibility

dependents of active duties, retired personnel & their dependents, former spouse , disabled child,

billin info

file claim ASAP, Max. fee paid for procedure is set by state, & recipient cannot be billed for procedure not covered bt Medical-Cal

CHAMPUS

funds are provided from the federal taxes & claims are handled by Fiscal Intermediaries

Medicaid/Medi-Cal

is also government sponsored & funds are provided from federal, state, & local taxes & benefits vary from state to state

MA's responsibility

know how to bill insurance, maintain a tracking system for insurance claims filled, follow-up insurance claims not paid in a timely manner

Medicare

largest benefit grogram in the country

medicare two part coverage

part A & part B

Medicaid/Medi-Cal

person covered by SSI, AFDC, income below 6,810/ year for single individual & 9,190/yr for couple, and pregnant women/ mothers MUST have infants up to 1 y/o

what are eligibility for medicare?

person over 65, retired on social security acts (SSA), spouses age over 65 , or person receiving social security disability benefits for over 2 years

Medicare is always the ________ carries and should be billed ____________

primary, first

Billing information for medicare

use HIC form 1500, file claim ASAP, participating physician accepts payment by Medicare as full payments and cannot bill pt for the difference