Medicare Billing

Medicare Billing topics explained. An overview of Medicare insurance, eligibility, and the unique requirements of the countries largest Health Care Provider.

Medicare is the 800 pound gorilla – it’s is the largest medical benefits program in the United States providing coverage for people age 65 and over and others who meet certain special conditions. They set precedents and policies that other health care insurance providers follow.

Medicare operates as a single-payer health care system. The Centers for Medicare and Medicaid Services (CMS) administers Medicare. CMS is responsible for managing the Medicare programs by selecting Medicare administrative contractors (called MAC’s) to process Medicare Part A and Part B claims. In our part of the country this is Cahaba Government Benefit Administrators.

Medical billing specialists working for providers typically don’t file Medicare Part A claims since these services are not provided in the provider’s office. Part A claims are filed using the UB-04 claim format by hospitals, clinics, and other inpatient health care providers.

Medicare Part B claims are filed with the information required in the CMS-1500 claim format which is usually transmitted electronically.

If you are in the process of enrolling a provider in Medicare, a helpful resource is “Medicare Enrollment – Completing the 855i” by Solutions Medical Billing on our Medical Billing Reference Books page.

This guide explains the Medicare enrollment forms necessary to complete the Medicare enrollment application correctly. If you’ve ever tried to fill out Medicare forms, you know this can be a confusing and time consuming process. Having a good guide to explain it and walk you through it can save a lot of time and effort.

Medicare Billing Topics
Following are some of the topics of interest to Medicare such as the different types of coverage and Medicare eligibility.

Health Care Reform Impact on Medicare and Medicaid
What is the impact of the 2010 Health Care Reform Act on the Medicare and Medicaid federal long term health care programs?

Medicare Provider Enrollment
What Medicare enrollment forms are necessary for a provider to participate. Learn whats involved with the Medicare provider application process and the benefits of Medicare provider enrollment.

Medicare Billing Codes
Medicare Billing Codes explained for Provider services and Hospital insurance as reported on the UB-04.

Who Qualifies For Medicare?
Who Qualifies for Medicare? Learn who qualifies and what the limitations are for Medicare eligibility.

Reporting Medicare Fraud
A basic guide that defines what Medicare fraud is, contact information for reporting it, what info to provide when reporting, and what happens when fraud is reported.

What Is Medicare Part A?
What is Medicare Part A, what’s covered, and what are the limitations for coverage.

What Is Medicare Part B?
What Is Medicare Part B insurance? Highlights of Part B coverage for services not covered by Part A Hospital insurance.

Medicare Part B Cost
Information on Medicare Part B Cost. What is Medicare Part B monthly cost for premiums. Learn how premiums change with income.

Medicare Part D Insurance
Explanation of Medicare Part D insurance prescription drug coverage and limitations.

Finding the Best Medicare Supplement
Finding the Best Medicare Supplements – Finding the best deals for Medigap insurance plans in your area. What to look for in selecting providers of supplemental medicare insurance.

Medicare Donut Hole
The Medicare Donut Hole explained. This is also been referred to as the donut hole in Medicare Part D prescription drug insurance program.

Medicaid vs Medicare
Medicare vs Medicaid – Discusses the differences between Medicare and Medicaid.

Secondary Coverage
When someone is covered by another health insurance plan, Medicare can be classified as the secondary payer when the patient is covered by employee sponsored or other government administered plans. The primary plan must be billed first. Medicare claims must be submitted after the EOB has been received from the primary carrier. The EOB must be attached to the Medicare secondary claim with the applicable service dates and procedures clearly identified.

Many times Medicare coverage doesn’t cover all the costs for beneficiaries. For these cases there is supplemental insurance, called Medigap, offered by commercial insurers that help to cover health care costs not reimbursed by Medicare. Medigap typically covers deductibles, coinsurance, and co-payments not covered by Medicare.