Medicare Billing Guidelines. Medicare is the national health insurance program of the United States administered by the Centers for Medicare and Medicaid Services (CMS), a federal agency within the US Department of Health and Human Services (HHS). This federal health insurance program subsidizes healthcare services to provide health insurance to individuals who are 65 years old or older; younger people with certain specific disabilities; people with permanent kidney failure requiring dialysis or a transplant, known as end-stage renal disease; and people with the motor neuron disease amyotrophic lateral sclerosis or ALS, often referred to as Lou Gehrig’s Disease.

Medicare is the health insurance plan covering around 60 million Americans (with a projected estimate of approximately 80 million by 2030), with automatic enrollment for those receiving benefits via Social Security. It is divided into four parts, each one designated for different healthcare costs. The different parts of Medicare, labeled A-D, help cover specific services related to hospital care, medical care outside of a hospital facility, and prescription drug access.

What Medicare Covers

Medicare Part A is specifically for hospital insurance. It covers costs for inpatient hospital stays, skilled nursing care, hospice care, and some home health care. Part A does not cover long-term care or custodial care.

Medicare Part B is for medical insurance. Part B covers outpatient care, including certain doctors’ services, including preventative care such as flu vaccinations. It also covers medical supplies and equipment, ambulance services, and mental health care.

Medicare Part C is for both hospital and medical insurance covered in Part A and B, plus other costs. Part C plans are purchased by individual consumers through private insurers rather than the federal government. Known as Medicare Advantage plans, they function as “all-in-one” alternatives to Original Medicare.

What is Original Medicare?

Original Medicare includes Medicare Part A and Medicare Part B and include fee-for-service plans, meaning one pays for services as they are received. Medicare Part C-type insurance plans have existed since the 1970s but were not formally established as Part C until 1997.

Medicare Part D is for supplemental prescription drug coverage. Medicare enrollees use Part D to receive subsidies for prescription drug costs; many brand-names and generic prescription drugs are covered under Medicare Part D, including many recommended vaccines, though each plan has a specific list. This optional benefit provided by private companies only is available to add to any plan. 

Medicare Billing Guidelines. Quick Claimers Medical Billing is a professional medical coding and billing company based in El Paso, Texas. The skilled team of coding and billing specialists at Quick Claimers can assist you with all your coding and billing needs. They are available now to organize and process claims for the healthcare services provided by your practice, to streamline your medical coding and billing processes. Contact Quick Claimers Medical Billing online or by phone at 915-351-6600 to discuss the services they can provide to you.


Written by: Erika Mehlhaff