Medicare & Medicaid
CMS rules, fee schedules, and program billing. 12 entries.
A dual-eligible beneficiary qualifies for both Medicare and Medicaid. Medicare pays first as primary; Medicaid pays sec…
How to Find Your MAC and LCD Before BillingTo confirm Medicare coverage before billing, identify your MAC by the state of service, check whether a National Covera…
MACRAMACRA, the Medicare Access and CHIP Reauthorization Act of 2015, repealed the sustainable growth rate formula and creat…
Medicare Administrative Contractor (MAC): Jurisdictions ExplainedA Medicare Administrative Contractor is a private company CMS contracts to process Fee-for-Service Medicare claims for …
Medicare Part AMedicare Part A is the hospital insurance half of Original Medicare, covering inpatient hospital stays, skilled nursing…
Medicare Part BMedicare Part B is the medical insurance half of Original Medicare, covering physician services, outpatient care, preve…
Medicare Part C (Medicare Advantage)Medicare Part C, or Medicare Advantage, is Medicare coverage delivered through a private plan that CMS pays a capitated…
Medicare Part DMedicare Part D is the outpatient prescription drug benefit, delivered through private plans that contract with CMS, ei…
Medicare Redetermination (First-Level Appeal)A Medicare redetermination is the first level of the five-level Medicare fee-for-service appeals process. A provider or…
Medicare Secondary Payer (MSP)Medicare Secondary Payer (MSP) is the set of federal rules that determine when another insurer must pay before Medicare…
Medigap (Medicare Supplement)Medigap, or Medicare Supplement Insurance, is a private policy that pays the deductibles, coinsurance, and copays a ben…
MIPS (Merit-based Incentive Payment System)MIPS, the Merit-based Incentive Payment System, is the CMS program that adjusts Medicare Part B payments up or down bas…
Want this handled instead of studied?
Our team lives in this material every day. Free billing audit — pay only when you get paid.
