Medicare is the federal health coverage plan that offers coverage to the elderly people who are 65 years old and above, a specific group of young people with disabilities and people with end-stage renal disorder. It normally offers hospital insurance, medical insurance, and prescription drug insurance. Hospital insurance entails coverage for the inpatient hospital stay, care in the skilled nursing facility and some home health. The medical coverage, on the other hand, offers coverage for the specific services of the doctor, preventive services and outpatient care. Medicaid, on the other hand, is a combined federal and state insurance plan that offers coverage to millions of the citizens of the USA who are living with low-income levels including the adults, pregnant women, children along with the people with disabilities. This program is normally administered by the states in strict adherence with the federal requirements. Moreover, to serve a more vulnerable population, the program can be modified to alter the criteria for selecting eligibility for the program. This essay, therefore, offers discussion on how Medicare affects medical billing, qualification for Medicare and Medicaid benefits and the effect ACA had on the Medicare and Medicaid recipients.
Medicare affects medical billing through granting the CMS mandate to select official Medicare administration contractors to process various claims associated with the Medicare which would considerably affect the medical billing process. The claims would impact the billing process since they would determine whether the individual is eligible for the medical billing offered by the program. Moreover, Medicaid would impact the medical billing through establishing various medical codes for the patients who must be incorporated to the medical billing software to ensure smooth billing of the patient after receiving treatment from a different health condition. Hence it impacts the medical billing through establishing medical code as a requirement that must be adhered to for the medical billing of an insured patient to be complete.
The Medicare program is typically available for those who are 65 years and above, people with end renal stage infection and the individual with the disability. For those who are 65 years old and above, they may automatically qualify for the Medicaid benefits when they are receiving social security disability insurance. SSDI is a social coverage plan that pays a monthly benefit to people who become disabled for reaching their retirement age thus incapacitating their ability to continue offering their labor. For one to be eligible for the SSDI, it is required that the person must have worked for a certain number of years in the job where the person was being paid social security taxes. Moreover, it normally pays for the benefit to the beneficiaries along with some members of the insured beneficiaries. Therefore, under the Medicare insurance plan, an elderly person of 65 years and above would only be eligible for this program if the elderly person is a beneficiary of the SSDI program. Additionally, for an elderly person of 65 years and above to qualify for the full benefits of Medicare program, it is required that the person and the spouse must have worked for long enough to be able to qualify for social security and railroads retirement benefits. Similarly, for individuals to qualify for the Medicare benefits, the individuals must convince and show that they are patients of kidney transplant or kidney dialysis.