HCR 202 Week 3 Government Payors Worksheet

HCR 202 Week 3 Government Payors Worksheet

Complete the University of Phoenix Material: Government Payors Worksheet.

Click the Assignment Files tab to submit your assignment.

Government Payers Worksheet

Complete Parts A and B of this worksheet.

References: Ch. 9, 10, and 11 of Medical Insurance: An Integrated Claims Process Approach (6th ed.)

Part A

Fill in the missing information by completing the table.

Identify the payer type, eligibility, coverage, and patient responsibility for Medicare programs, Medicaid, CHAMPVA, and Tricare.

Payer Type      Eligibility        Coverage         Patient Responsibility

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Medicare Part A                                  First 60 days responsibility is the annual deductible.

For days 61 to 90 there is a per-day copay and another per-day copay after days 91 to 150.

Beyond day 150, Medicare Part A does not make a payment.

Individuals entitled to Medicare Part A are automatically qualified to enroll in Part B.

Needs to be a U.S. citizen and over the age of 65 (voluntary program).

Physician services, outpatient hospital services, medical equipment, and other supplies and services.

Private health insurance companies contract with the Centers for Medicare and Medicaid to offer Medicare Advantage plans.

Medicare Part D                      Medicare prescription drug plan (private insurance plan).

Categorically needy    Administered at a state level. Each state determines the coverage and sets the payment rates.

Services include hospital, outpatient, physician services, laboratory, radiology. Some states include prescription services, vision care, vision, clinic services, and home and community based care.

Some may include a spend down program prior to reimbursement.

Individuals and families may be required to spend a portion of income or resources on health care, which is similar to a deductible.

Tricare                         Coinsurance for nonparticipating providers.

Annual enrollment and copays for retirees and families.

Government health insurance program for families of veterans with 100% services related to disability.    Includes most all treatment with the exception of unnecessary services and supplies.

Does not include experimental treatment, custodial care, or dental care.

Part B

Write a 50- to 150-word response to each of the following questions. Use your own words and provide examples to support your answers.

Why is it important to understand the guidelines for timely claim filing from the date of treatment or discharge?

Why is it important to understand the different payer coverage and patient responsibility?

Cite any outside sources. For additional information on how to properly cite your sources see the Reference and Citation Generator resource in the Center for Writing Excellence.