Medicare

Medicare - known as the "Title XVIII" Entitlement - is the federal health insurance program created in 1965 for people ages 65 and over, regardless of income, medical history, or health status. The program was expanded in 1972 to cover people under age 65 with permanent disabilities. Today, Medicare plays a key role in providing health and financial security to 55 million older people and younger people with disabilities. The program helps to pay for many medical care services, including hospitalizations (Part A), physician visits (Part B), and prescription drugs (Part D), along with post-acute care, skilled nursing facility care, home health care, hospice care, and preventive services. Medicare spending accounted for 15 percent of total federal spending in 2015 and 23 percent of national personal health spending in 2014. 

 

Medicare beneficiaries can also enroll in a private health plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO), and receive all Medicare-covered Part A and Part B benefits and typically Part D benefits (Part C, or "Medicare Advantage"). Enrollment in Medicare Advantage plans has grown over time, with nearly 17 million beneficiaries enrolled in Medicare Advantage plans in 2015 - 31% of all Medicare beneficiaries (KFF). The tremendous growth and popularity of Part C plans has created much ambiguity within the reimbursement and cost reporting arena, with recent rulings resulting in mixed consequences and timelines for providers. Medicom's management has directly participated in data and regulatory supporting roles within the PRRB Appeal and litigation channels to confront this issue.

 

​The Medicare Federal insurance entitlement has been - and will continue to be for quite some time, a major budget component effecting hospital reimbursement cost centers from many angles. Medicom addresses the most significant regulatory issues which play a critical  role within the CMS cost reporting cycle.