Healthcare costs are increasing with each passing day, and for many people getting necessary medical care can be a financial burden. Healthcare can be quite expensive, considering all the various medical costs from diagnosis, testing, scans, lab work to emergency care, surgical procedures, and post-treatment consultation. Since March of 2020, patients now have the added concerns of expenses related to the COVID-19 pandemic.
FAQS ABOUT FAMILIES FIRST CORONAVIRUS RESPONSE ACT AND CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT IMPLEMENTATION PART 42
Set out below are frequently asked questions (FAQs) regarding implementation of the Families First Coronavirus Response Act (the FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), and other health coverage issues related to Coronavirus Disease 2019 (COVID-19). These FAQs have been prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments). See some line item FAQs and answered questions from stakeholders to help individuals understand the law and benefit from it, as intended.
Medicare COVID-19 coverage:
- When tests are available for you in your state, Medicare covers and you pay nothing for:
- Tests to diagnose or aid the diagnosis of COVID-19,
- Some tests for related respiratory conditions to aid diagnosis of COVID-19 done together with the COVID-19 test
- Medicare covers these tests at different locations, including some “parking lot” test sites.
- Medicare also covers Covid-19 antibody tests,COVID-19 monoclonal antibody treatments, and COVID-19 vaccines.
What is the Medicare Insurance Program?
Medicare is a government-supported insurance program that provides health coverage to an individual who is
- Above 65 years or older
- Under 65 years and suffering from some disability or on dialysis
Medicare is provided to eligible individuals irrespective of their income. The insurance payments are done partly through deductibles, and the patients are said to pay only a small amount to get non-hospital coverage. Medicare is divided into four categories or parts such as
- Part A - Hospital Coverage
- Part B - Medical Insurance
- Part C - Supplemental Insurance
- Part D - Prescription Coverage
Individuals 65 years or older get free hospital coverage, but any additional costs not covered require payment from the individual.
Individuals eligible for Part A also qualify to receive benefits of Part B that includes emergency equipment and services such as wheelchairs, x-rays, walkers, and visits to the doctor. Many preventive services are also provided, such as disease screenings, vaccinations, and flu shots. However, to receive Part B coverage, one must pay a monthly premium, deducted from Retirement payments or Social Security.
Individuals who qualify for Part A and B can easily benefit from supplemental insurance, also called ‘Medicare Advantage’. The plan covers dental, and vision care and a person has to pay separately to get enrolled.
People eligible for Part C can benefit from prescription coverage, but a person has to pay on his own to get enrolled. One also has to make monthly premium payment along with annual deductibles, and co-payments for various prescriptions.
Medicaid COVID-19 coverage:
Medicaid and CHIP provide comprehensive benefits to people who are determined eligible by states. Some benefits are required and some are optional. For information on benefits offered in your state, where to access services and how to apply for coverage in your state, see Medicaid.gov.
What is the Medicaid Insurance Program?
Medicaid is both a federal and state-run insurance program offered to everyone who has a low income. The patients mostly do not have to pay any premiums or part of the cost incurred in a medical expense. However, an individual may be asked for a co-payment sometimes. As Medicaid is a federal-state program, the rules and policies vary from one state to another.
There are almost 50 different Medicaid programs for each state, and an individual may apply for the insurance program according to state income requirements. Medicaid is the best insurance program for those who have already paid expensive medical bills and have limited means to further manage costly healthcare bills.
However, individuals and families have to go through the eligibility process as per the state criteria and rules of the state. According to statistics, nearly 75 million people get the Medicaid services from adults, children, poor to elderly, pregnant women, and disabled.
If a person is eligible for both Medicare and Medicaid, he will be known as ‘Dual eligible’. A person eligible for Medicaid can easily avail Medicare services when he/she turns 65 years of age. The Medicare insurance plan cost is covered through premiums that people pay for certain plans and payroll taxes. Medicaid insurance, on the other hand, does not require any premium payment.
How Health Insurance Program Work
A medical or health insurance works similarly to the car or house insurance. In a typical health insurance coverage, an individual usually pays a certain amount of premium, and the insurance provider will cover the medical expenses and make payments to the medical practice or hospitals.
Healthcare costs can be expensive from a scheduled appointment to the medical services rendered in times of illness or injury. People who are young and healthy require low medical costs as compared to the high medical costs of old age people who are suffering from chronic ailments.
Since many people remain healthy most of the time, the premiums made by them are used by insurance providers to cover the expenses of those individuals who require immediate or constant medical care. In many health insurance plans, a person has to pay ‘deductible’ which is an amount that is paid at the start of every year so to cover the medical expenses. Once a deductible is made, an individual can get the treatment and care according to his plan, and the insurance provider will cover the costs.
A copayment is a fixed amount of fee that you have to pay to get different covered services in the insurance plan, such as a visit to the doctor, or emergency care. Coinsurance is also a percentage payment that you have to incur for different covered services such as getting a specific medical test or consulting with a specialist doctor.
How a Medical Practice Integrates with Health Insurance
A hospital or medical practice functions by managing a revenue cycle by either making collections from the insurance providers and by people who receive the medical services. For example, a person having a particular health insurance plan can schedule an appointment, get the necessary diagnosis, treatment, or prescription and all the cost can be deducted from the plan.
The medical practice will prepare a medical bill based on all the services rendered to the patient and send the claim to the insurance provider to get full reimbursement. A regular payment collection system from insurance companies is vital for a medical practice to financially sustain and deliver quality care.
Without a steady income or revenue flow, a medical practice cannot function or stay operational and even more so in times of global pandemic such as Covid-19 that has decreased the number of patients coming in for emergency treatment or regular check-ups. The core function and value of medical practice is providing healthcare services along with billings, collections, and revenue cycle management.
As most healthcare centers are reimbursed from third-party payers, it can be challenging for a health center to function as there is a lag or gap in rendering medical services and receiving payments from insurance companies. Moreover, more than 50% of medical claims are rejected and denied by insurance companies due to incorrect medical coding and incomplete billing documentation.
With growing medical costs, financial losses and other challenges due to Coronavirus pandemic, it is imperative for a medical practice to incorporate innovative solutions such as medical billing and coding software that can reduce the coding and billing errors and optimize the revenue stream.
It is important to have or outsource a billing company that has the most up to date medical billing software as numerous features such as instant verification of patient’s insurance eligibility, integration with EHR, easy selection of different complicated and updated medical codes, HIPAA compliance, online claim submission, and tracking of unpaid bills. Contact one of our specialists with PETTIGREW to get more information on how we can partner with you.
Why Health Insurance is considered Important
Health or medical insurance helps an individual cover the high and unexpected costs that a person would likely pay on his own in times of injury or illness. Health insurance is a safety net that can help you avoid large medical bills that can result in financial constraints and even bankruptcy. With a health insurance plan, you can get
- Treatment for any acute or chronic illness
- Preventive care to avoid any long term chronic ailment
- Necessary care services for sudden illness or injury
- Annual check-ups and vaccinations
- Medical scans and screenings
The main purpose of health insurance is to pay for the medical bills and help you get the necessary help and care you require. There are numerous kinds of healthcare plans and coverages offered by government and private insurance companies, but there are significant differences in options and cost of the two. However, a person can select an insurance plan for himself and his family according to his financial stability, monthly income, credit history, and family size.
The two most popular state and federal health insurance services in the country are ‘Medicare’ and ‘Medicaid’. The rules and eligibility guidelines of the two insurance programs are the same throughout the country, and are managed by Centers of Medicare & Medicaid Services popularly known as CMS.
In the healthcare industry, CMS plays a crucial role in collecting and analyzing medical data, eliminating frauds, providing access to numerous insurance plans, and improving the overall healthcare system.
CMS manages HIPAA (Health Insurance Portability and Accountability Act) that includes rules and standards to maintain patient health information and prevent any misuse of clinical data. CMS also strives to integrate Electronic Health Records (EHR) to form a single database for patient medical information and history.
Both Medicare and Medicaid were formed in 1965 due to the inability of older people and those having a low income to buy private health insurance plans. The goal of the two programs was to make quality healthcare service accessible to every individual of the country.
There is also ‘Employer-based health insurance’ where a business organization may purchase an insurance plan on behalf of its employees which may cover some or all of the premium cost. The employees, on the other hand, may be asked to pay some amount as premium through deductible, copayment, or coinsurance.