Question

1.How do we Determine whether Medicare is primary or secondary and how do we determine additional benefits?   

2. With what ACT & what YEAR did Medicare come into being?

3. If the Medicare guidelines are not known for a certain procedure or service, ask the patient to sign a(n) _______________________.

Answer 1

When Medicare is Primary

Primary insurance means that it pays first for any healthcare services you receive. In most cases, the secondary insurance won’t pay unless the primary insurance has first paid its share. There are a number of situations when Medicare is primary. Learning about them ahead of time will help you avoid costly enrollment deadlines.

When Medicare is Secondary

Secondary insurance pays after your primary insurance. It serves to pick up costs that the primary coverage didn’t cover. For example, if your primary insurance has a $1000 deductible, but your secondary insurance has a $500 deductible, your secondary would kick in to pay $500 of that $1000 bill. This is, of course, a very simple example but in general your secondary insurance will serve to reduce the overall expenses that you have out of pocket.

2- Like Medicare, Medicaid is overseen by the Centers for Medicare and Medicaid Services of the Department of HHS. Both were created whenPresident Lyndon B. Johnson signed amendments to the Social Security Acton July 30, 1965.

3- If the Medicare guidelines are not known for a certain procedure or service, ask the patient to sign a(

Advance Beneficiary Notice (ABN) CMS-R-131.