Aspen University Qualifications to Receive Medicare and Medicaid Discussion

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wrffl74

Health Medical

Aspen University

Description

Assignment: Module 8:

  • How does Medicare affect medical billing?
  • Briefly define the qualifications for Medicare and Medicaid benefits.
  • Describe the impact that the ACA has had on Medicare and Medicaid recipients.
  • Length:
    • 1000-1250 words (4-5 pages); answers must thoroughly address the questions in a clear, concise manner
  • Structure:
    • Include a title page and reference page in APA style
  • References:
    • Two scholarly references are required; you should include the appropriate APA style in-text citations and references for all resources utilized to answer the questions

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Explanation & Answer

Attached.

Running head: MEDICARE AND MEDICAID

Medicare and Medicaid
Institutional Affiliation
Date

1

MEDICARE AND MEDICAID

2

How Medicare Affects Medical Billing
Medicare operates like a sole payer healthcare system which pays insurance firms for
services offered to individuals who have subscribed for different programs. Healthcare providers
today, whether organizations or licensed practitioners, earn most of their income from medical
services offered to Medicare beneficiaries. This program impacts medical billing in various
ways. Medicare covers for both inpatient services provided within the hospital, and follow up
nursing services offered outside the hospital (Mayes & Berenson, 2006). It also covers for
healthcare services provided in a home, hospice, or a religious non-medical facility. However,
this section of the Medicare program requires patients to cater to a deductible out of pocket fees
before Medicare covers for benefits. After paying the deductible, Medicare pays for all care
services for the first 60 days beyond which a set co-payment is agreed on, for every extra day.
When the inpatient stay exceeds 90 days, high co-payments are incurred. Inpatient care coverage
for more than 90 days is limited on the basis of a lifetime.
Reimbursement to the hospital is made based on DRGs (diagnosis-related groups),
which means that payment for a certain amount is guided by the documented medical condition
of the patient in the medical record (Mayes & Berenson, 2006). In the second category of the
program, Me...


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