More than one fourth of all healthcare services are paid by the federal government, making it “the largest single payer of health care in the United States” (Troy, 2015, p. 1). For providers, dealing with the nation’s largest payer requires a deep understanding of the different government-sponsored plans in terms of coverage, rules, and regulations related to care and payment for services (Harrington, 2016). Because there are so many options for coverage and payment, it is important for the healthcare administrator to understand proper billing procedures to help maintain the financial health of the organization he or she represents.
- Identify and describe the basic characteristics (e.g., the beneficiaries, services covered, who administers it, etc.) of the plan you chose.
- Outline the eligibility requirements for coverage for the targeted population.
- Discuss how participation (or lack of participation) in the plan impacts healthcare organizations.
https://www.cms.gov/Medicare/Billing/ElectronicBil…
https://www.cms.gov/About-CMS/Agency-Information/H…
https://oig.hhs.gov/oas/reports/region1/11100532.p…
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