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