The birthday rule is a health insurance coordination policy used to determine which parent’s plan will be the primary payer when a newborn or child is covered under both parents’ health insurance. Despite how it sounds, the birthday rule doesn’t prioritize age—it goes by calendar date. In Simple Terms: This rule is widely followed by … Read more
Let’s not overcomplicate this. If you’ve ever looked at a patient’s Medicare claim and wondered, “Who handles the secondary payment?”, you’re asking the right question. That’s exactly where crossover claims come into play. In this guide, we’ll unpack what a crossover claim really is, how it flows through the system, what makes it different from … Read more
DRG: DRG system payment depends on the following factors: DRG-Related Weight: Hospital Payment Calculation:
Medicare is a federal health insurance program mainly for people 65 and older, and for younger individuals with disabilities or serious conditions like kidney failure. If you’re a kidney patient, understanding Medicare helps you get the care you need without surprise costs. Here are the Medicare basics: Key LSI Keywords: federal health insurance, Medicare eligibility, … Read more
Revenue Cycle Management is used in the healthcare system of the United State of America. It is useful to track the revenue for providers for the services taken by patients. It starts with a patient appointment when a patient needs any treatment or patient has any illness and ends up with the resolution of service … Read more
12 – Working Aged Beneficiary or Spouse with Employer Group Health Plan 13 – End-Stage Renal Disease Beneficiary in the 30-Month Coordination Period with an Employer’s Group Health Plan 14 – No-fault insurance, including auto, is primary (any no-fault insurance) 15 – Workers’ Compensation … Read more
1) These are the Medicare programs established to help low-income beneficiaries where Medicaid pays their Medicare Part A & Part B premium, Medicare coinsurance, and Medicare Deductible. 2) Below are the Medicare programs and their covered benefit, 3) You will find a scenario where a claim was paid by Medicare as primary and Medicaid denied … Read more
