Reimbursement

Question 1

Medicare

Answer 1

by CMS under the direction of HHS

Question 2

Medicaid

Answer 2

Federal/State sponsored program, is a Federal program administered by state. State determines who is eligible, offers healthcare coverage for low-income families

Question 3

Who is covered by Medicare?

Answer 3

Federal coverage for >65 years, permanently disabled, end-stage renal disease who have met with waiting period requirements. Divided into 4 parts - A,B,C,D

Question 4

Medicare Part-A covers

Answer 4

Inpatient hospitalization, hospice care, skilled nursing care, home health care. Automatic coverage for those eligible.

Question 5

Medicare Part-B covers

Answer 5

Outpatient lab tests, physician professional services, other outpatient medical services and devices. No automatic coverage. Those eligible must be enrolled.It is baseline that private insurance payers use to establish their own payment rates.

Question 6

Medicare Part-C covers

Answer 6

Also known as Medicare Advantage Plan, alternate to Part-B, HMO-type coverage plan

Question 7

Medicare Part-D covers

Answer 7

Prescription benefits

Question 8

What is Self-pay or out-of-pocket?

Answer 8

Fees and services not covered by insurance or govt.

Typical in poor countries.In US, reserved for elective testing, infertility testing and genetic testing. Lab sets a fee.

Question 9

Types of private insurance

Answer 9

Managed care and Fee-for-service