Medicare sets the billing standards for all insurance companies. Learn how Medicare providers and suppliers are reimbursed for the items and services that they furnish, as well as how Medicare determines the services that they will deny. This course will focus on the different types of Medicare plans, Original Medicare (Part A and Part B), Medicare Advantage Plans (identified as Part C or MA), and Medicare Part D (PDP or Prescription Drug Plan). The differences between Medicare Part A (which includes hospitals, skilled nursing homes, hospice, and home health services) and Part B (provider billing, radiology and laboratory services, as well as speech, occupational, and physical therapy services, and DME [Durable Medical Equipment]) are addressed. Allied health care providers, such as chiropractors, podiatrists, optometrists, and some mental health care professionals, also participate in the Medicare program. These services and their payment methods are also discussed. In some cases, Medicare is the not the primary insurance; Medicare Secondary Payer is also thoroughly reviewed. Terms and expressions related to Medicare are covered. Medicaid, which is the federal and state funded medical assistance program is covered. This plan is designed to provide comprehensive medical care with special emphasis on children, pregnant women, the elderly, and the disabled. TRICARE, the insurance for (active and retired military and their dependents) is covered in this course.
This course focuses on the specific rules, procedures and forms required for the proper submission of reimbursement under these types of insurance plans. Specific case scenarios are utilized to enhance the student’s understanding of the reimbursement of medical claims.
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