Question

This week you are learning about the medicare and medicaid government programs. Each of these provide different types of healthcare coverage for specific groups of people. Read the following scenario and answer the discussion prompts for this week. Part of your job duties as a medical claims specialist in Dr. Johnson's medical office is to verify the patient and insurance information, the assigned codes for services provided, and the dates of service for each claim are correct before they are sent to Medicare for reimbursement. You notice the insurance information listed for the patient on the claim is Medicare Part A and the codes are for evaluation and management services. 2. Initial post: Create a new thread and answer all three parts of the initial prompt below: 1. Explain why billing Medicare Part A for the listed service is or is not correct. 2. Summarize the types of services Medicare Part A reimburses. 3. Discuss the type of services Medicare Part B covers.

Answer 1

1. Billing Medicare Part A for evaluation and management services is not correct. 2. Medicare Part A reimburses for inpatient hospital stays, skilled nursing facility care, hospice care, and limited home health care. 3. Medicare Part B covers physician services, medical tests, outpatient visits, preventive services, durable medical equipment, and some home health care services.

Step-by-step explanation:

Billing Medicare Part A for evaluation and management services is inappropriate as it primarily caters to hospital-related expenses and generally does not provide reimbursement for outpatient services, including evaluation and management services.

Its coverage focuses on inpatient hospital stays, skilled nursing facility care, and hospice care.

Medicare Part A offers reimbursement for specific services, including inpatient hospital stays, skilled nursing facility care, hospice care, and limited home health care.

Medicare Part B, on the other hand, encompasses various services such as physician services, medical tests, outpatient visits, preventive services, durable medical equipment, and certain home health care services.