Final answer:
A Medicare claim missing required information is considered incomplete or rejected, requiring resubmission with the correct data. Moral hazard and adverse selection are important concepts in the insurance sector, which also affect Medicare and Medicaid, especially under the ACA's regulations.
Step-by-step explanation:
A Medicare claim that is missing required information is considered to be an "incomplete" or "rejected" claim. This means that Medicare will not process the claim until all the necessary information is provided. Such missing information may include pertinent patient details, diagnostic codes, or supporting documentation necessary for claim adjudication. Providers are then required to resubmit the claim with the correct information.
In the context of healthcare insurance, moral hazard refers to the tendency of insured individuals to use more medical services than needed because they do not directly bear the cost of these services due to their coverage. This contrasts with adverse selection, which occurs when individuals with a higher risk of requiring healthcare are more likely to purchase insurance, potentially raising costs for insurers. Both of these economic concepts are relevant to programs like Medicare and Medicaid, as well as to the broader insurance market impacted by regulations such as the Patient Protection and Affordable Care Act (ACA or Obamacare), which aims to mitigate these issues.
Medicare operates primarily on a fee-for-service model, where healthcare providers are reimbursed for each service they provide to patients rather than being paid on a capitation or salary basis. Proper claim submission is crucial to ensure that healthcare providers are compensated for their services under this system.