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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
- 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.