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Accurate Coding for Medicare and Medicaid Reimbursement

March 24, 2012 | Comments: 0 | Views: 122

Medicare and Medicaid - Administration and Coverage

Many people are confused about these two programs and are not fully aware of the difference between the two. Medicaid is a program aimed at low income people and is governed differently in different states in the US. Medicare is a federal program created for the benefit of older citizens who find it difficult to bear the huge medical costs in the light of their lower earning capacity. Medicare is an entitlement program and you have to apply for it at the local social security office.

Medicaid is beneficial for pregnant women, people who need nursing home care, disabled individuals, elderly people who are 65 and above, children under 19 and blind people who fall in the low income group. To apply for the Medicaid program, you have to apply via your state's Medicaid agency. Medicare is for people aged 65 and above, people of any age who have long term kidney disease or kidney failure, and people on Social Security disability.

• Being a federal program, Medicare rules are the same all over the country and all related information is available at your local Social Security office. Medicaid is administered by the states independently and rules are different in each state. Any information pertaining to Medicaid can be obtained from your local county social services, welfare or department of human services office.

• Medicare Part A is hospital insurance that offers basic coverage for hospital stay, post hospital nursing facility and home healthcare. Medicare Part B is medical insurance that reimburses basic laboratory and physician costs, and certain outpatient medical services including medical equipment and supplies, physical therapy and home health care. Cost of prescription medications is covered to some extent under Part D Medicare prescription drug coverage.

• Medicaid offers complete inpatient and outpatient healthcare coverage and this includes many services Medicare doesn't reimburse such as diagnostic and preventive care, prescription drugs and eyeglasses. The amount reimbursed might be different in different states. Medicaid can pay the Medicare premium as well as Medicare deductibles and twenty percent portion of charges not reimbursed by Medicare.

• Looking at the costs the consumer incurs with these two programs, Medicare requires you to pay a yearly deductible for Part A and Part B. Rather heavy copayments are to be made for extended hospital stays. Part B of Medicare charges a monthly premium as well. Moreover, the consumer has also to pay twenty to thirty five percent of physicians' bills that Medicare does not pay. If the consumer is not in the low income group, he/she will have to pay a monthly premium, copayments, a deductible and all prescription drug costs over an allowed yearly amount and up to a maximum amount.

• Medicaid is a welfare measure for the low income group and in some states it might charge small amounts for certain services. If a person is found eligible for both Medicare and Medicaid on the basis of certain eligibility requirements, Medicaid will reimburse most Medicare Part A and Part B premiums, copayments and deductibles.

Medical Coding - Outsource Strategies International (OSI) provides medical coding services to a range of Medicare/Medicaid clients including medical groups, clinics, and independent physicians in the US.

Source: EzineArticles
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