Sunday 18 September 2016

Medical billing insurance overview

TYPE Of Insurance

There are two kind of Insurance Companies

There are :

Federal Insurance Companies

MOTIVE IS WELFARE

Examples : 

Medicare
Medicaid
CHAMPUS (Civilian Health and Medical Program of the Uniformed Services)
CHAMPVA (Civilian Health and Medical Program of the Veterans Administration)


Commercial Insurance Companies

MOTIVE IS PROFIT

Examples:

Aetna
Cigna
BCBS
Humana

MEDICARE ELIGIBILITY

Who is eligible for Medicare?

People age 65 or older

People under age 65 with certain disabilities.

People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a  transplant).

Decide how to get your Medicare Coverage

Traditional Medicare includes:
Hospital Insurance (Part A)
Medical Insurance (Part B)
You will need a separate plan for your Part D, 
Prescription Drug Coverage.

Medicare Advantage Plan:
Combines Part A, Part B and usually Part D 


Medicare has Two Parts:

Medicare has Two Parts:

Part A (Hospital Insurance)
 Most people don't have to pay for Part A.

Part B (Medical Insurance)
 For Part B benefits patient has to pay monthly premium  of $99.90 in 2012, a $15.50 decrease over the 2011 
 premium of $115.40.

Two type of Providers

Participating provider 
and
 Non-Participating provider


Two type of Providers

What is the difference between "participating" and "non-participating" providers?

Participating provider :-  

Participating providers have a signed contract with Insurance.

Benefits:-
More patients
Assured payment from Insurance Company
Need to follow Insurance fee schedule


Non Participating provider :-  
Non Participating providers will not have any contract with Insurance.

Benefits:-
Members are responsible for the total amount billed
High value of billed amount
High Copay from patient
High Reimbursement

Disadvantange:-
Less patients visits.

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