Radiology billing and coding tips. Learn about radiology billing services health care CPT codes and reimbursement. How to do Radiology billing correctly. PET CT scan coding and Guidelines.
Tuesday, July 14, 2015
Medicare Basics
Medicare was established in 1965 and is currently the world's largest insurance program.
The Centers for Medicare & Medicaid Services (CMS) administers Medicare, Medicaid and the State Children's Health Insurance Program (SCHIP). CMS also oversees the day-to-day operations of Medicare contractors.
The Social Security Administration (SSA) determines Medicare eligibility. To be eligible for Medicare, an individual must meet one of the following requirements:
• 65 or older
• Under 65 with certain disabilities
• Any age with End-Stage Renal Disease (ESRD)
There are four basic parts of Medicare:
Part A (Hospital Insurance)
• Hospital
• Skilled Nursing Facility (SNF)
• Home Health
• Hospice
Part B (Medicare Insurance)
• Doctor
• Ambulance
• Lab, X-Ray
• Durable Medical Equipment (DME) & Supplies
Part C (Medicare Advantage)
• Receiving Parts A and B (and often D) through a private plan
Part D (Rx Drug Coverage)
• Only available through private plans
If an individual is already receiving SSA benefits, enrollment in Part A and Part B is automatic when he/she becomes eligible (age 65 or 25 months of disability payments). If an individual is not receiving SSA benefits, he/she can contact SSA to enroll:
• We recommend individuals to contact SSA within three months of turning 65
• An individual can enroll in Medicare without retiring
Individuals who have to sign up for Part A and/or Part B may enroll during designated enrollment periods:
• Initial Enrollment Period
• General Enrollment Period
• Special Enrollment Period
Part A is free if an individual has 40 quarters of work history. If you do not have the work history, you can enroll in Part A (and pay a monthly premium) if you meet the following conditions:
• 65 years or older
• United States citizen or lawfully admitted for permanent residence for five years
The Part B monthly premium is automatically deducted from a beneficiary's SSA check or billed to the beneficiary.
As introduced earlier, there are four parts of Medicare. Select each of the links below for a closer look at each part.
• Part A
• Part B
• Part C
• Part D
Medicare does not cover all procedures. Select the link below for a list of common exclusions for traditional Medicare.
• Exclusions
A Medicare card is issued to every person entitled to Medicare benefits. Each card contains the following information:
• Name (as it appears on Social Security records)
• Medicare Health Insurance Claim (HIC) number
• Medicare Part A and/or B entitlement dates
Collecting the correct insurance information is very important to ensure correct billing. It is a good practice to ask for all beneficiary insurance cards. Beneficiaries who opt to enroll in an MA plan may have two insurance cards.
Verifying Medicare eligibility is a daily task in medical facilities and it's imperative this is completed without violating the beneficiary's privacy. Part B providers can verify beneficiary eligibility through the Interactive Voice Response (IVR).
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Radiology basic billing
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