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Medicare Parts and Coverage Requirements

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Medicare Parts and Coverage Requirements

Medicare is a federal health-insurance program for people aged 65, including those under the age of 65 who have certain disabilities.

  • Age 65 or older
  • Disabled
  • End-Stage Renal Disease (ESRD)

Four Parts of Medicare

Medicare is divided into four parts: Part A, Part B, Part C, and Part D.

  • Part A covers inpatient including critical access and long-term care hospital stays.
  • Part B Outpatient/medical coverage is provided by Doctors.
  • Part C Medicare Advantage Plans provides an alternative method of receiving Medicare benefits.
  • Part D Prescription drug coverage is provided.

Overpayments on Medicare:

  • When Medicare discovers an overpayment, the amount becomes a debt due by the provider to the federal government.
  • Under federal law, Medicare is required to recoup all overpayments that have been identified.
  • Medicare overpayments are frequently caused by incorrect coding, insufficient documentation, medical necessity issues, and processing and administrative errors.
  • Within 60 days of discovery, Medicare overpayments must be reported and returned.
  • Perform a billing audit Plan a medical billing audit, either internally or externally.
  • Noncompliance with the Medicare overpayments requirement might result in False Claims Act liability, as well as monetary penalties and exclusion from federal healthcare programs.

For additional information, please contact us at +1440-209-5122 or