Professional Medical Billing | Medicare Parts A, B, C, and D for Medical Billers

As a medical billing instructor I am frequently asked about the different parts of Medicare and what they cover. This article will break down Medicare parts A, B, C, and D to clarify which each part covers.

Medicare Part A- Pays for inpatient medical services, hospice care, and some home health services. Examples of Medicare  Part A coverage: Hospitalizations, Skilled Nursing Facility, Home Health, Hospice care. Claims are usually submitted on the UB-04 form. Part is not paid for if the person worked for 10 years in Medicare-eligible employment.  If one did not, and wants to buy in, it can cost anywhere from $250-$450 a month.

Professional Medical Billing | Medicare Parts A, B, C, and D for Medical Billers

Medicare Part B- Pays for outpatient services like doctor’s visits, and physicians for inpatient services. These claims are submitted on the CMS-1500 form. Premiums are based on annual income. Example: Married, making under $170,000 a year= $123 a month.

Medicare Part C-  This is a Medicare option allowing a “choice” of managed care options. These claims can use either a UB-04 or CMS-1500 form depending on what services are being billed. Part C is like a partnership between private fee-for-service plans  that provide care to Medicare patients.

Medicare Part D- Always remember “D” for “drugs.” This is the part of Medicare that covers medications.

• General requirements to be eligible for Medicare is working in a Medicare -covered employment for at least 10 years.
• Be at least 65 years told
• Be a US citizen or permanent resident alien of the USA

People age 65 who already receive social security, Railroad Retirement,  or disability benefits  are automatically enrolled in Medicare Parts A and B effective on the month of their 65th birthday.

A professional medical billing student or new medical biller in the field should learn all they can about Medicare and Medicaid rules, regulations, what is covered and what is not.

By: Dawn Moreno, PhD, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years. Interested in quality medical billing training?  More of Professional Medical Billing Courses

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