Medicare Billing : Who pays what? When do things get paid?

The world of Medicare billing has multiple levels due to it’s many different levels of service. Not all medical billers have the type of training and understanding of Medicare processes and regulations that is required to do Medicare billing. This billing is preformed by billers with focused training on Medicare, making it their field of expertise.

What Medicare Part A Covers And How It Is Paid

Part A covers in-patient stays including home-health and hospice. According to Wikipidia, the deducible of$1,068.00 (2009) is patient responsibility, unless there’s secondary insurance. When the patient is discharged from the hospital, a bill is calculated and sent electronically to Medicare. Once the claim is submitted it is approved for payment. If there are errors on the claim, they must be corrected and the claim resubmitted. Once a “clean” claim is excepted by Medicare, payment is issued in fourteen days.

What Medicare Part B Covers And How It Is Paid

This part covers physicians and nurses services and other outpatient procedures such as x-rays, vaccinations, cancer treatments, diagnostic tests, and dialysis. Part B also covers medically necessary equipment such as walkers and wheelchairs. Services are submitted and paid the same as Part A claims. These claims may also have deductibles and co-pay charges that are patient responsibility, unless there’s a secondary insurance.

What Medicare Part C Is And How It Is Paid

This portion is Medicare Advantage Plans that include prescription drug coverage. These plans are purchased through private insurances and take the place of regular Medicare Parts A & B. Claims are submitted directly to the private insurance and are paid according to Medicare guide-lines. Many companies do not allow for a secondary insurance, making the co-pays and deductibles patient responsibility.

What Medicare Part D Covers And How It Is Paid

The prescription plan is covered under D. The recipient of this plan must be covered by both Medicare A & B for Medicare Part D eligibility. Most medical facilities require the patient to send the claims for this plan.

Medicare billing is tricky business, but easily accomplished when left in capable hands.

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