1. Age-Based Eligibility 2. Work History or Spousal Coverage 3. Early Enrollment Options 4. Medicare Parts & Enrollment Essentials Part Overview Eligibility / Timing Part A Hospital Insurance Free with 40 credits; otherwise paid Part B Medical (Doctors, Outpatient) Enrollment typically at 65; late penalties if delayed Part C Medicare Advantage (via private insurers) Must … Read more
Payment calculation without sequestration, Billed Amount = $40.00 Allowed amount = $20.00 Paid amount = $16.00 Patient responsibility (Coinsurance) = $4.00 Payment calculation with sequestration, The sequestration … Read more
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
Rejection: Below are a few most common rejections with resolution steps: 1) Policy ID invalid / Patient or Subscriber not identified: I) When a claim is billed with an incorrect policy ID: Insurance Policy ID Format Policy ID Examples 1199 SEIU FUNDS 10 digits number 1234567890 AARP 11 digits number 12345678901 Aetna 10 digits … Read more
1. Patient Name 2. Patient DOB 3. Referring Doctor 4. Rendering Doctor 5. Service Location Information 6. Exam time 7. CPT code with description 8. Indication: It indicates the sign and symptoms … 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
