Department of Health and Human Services

In this discussion we will talk about the regulatory considerations of Medicare, one of the two major government third-party payers. In your initial post please address the following questions:

Medicare provides medical benefits to individuals age 65 and older. It contains three parts A, B and C.

What are the major aspects of these benefits?

“The Medicare program falls under the Department of Health and Human Services (DHHS), which creates the specific rules of the program on the basis of enabling legislation. Medicare payments to providers are not made directly by Centers for Medicare and Medicaid Services (CMS) but by contractors at state or local level called intermediaries for Part A payments and carriers for Part B payments.” (Cleverley, 2010, Instructor Manual)

  • What are the implications of the methods of reimbursement for an organization’s resource management?
  • Should hospitals and physicians “undercode” Medicare patient stays and patient visits in order to reduce the possibility of being charged under the False Claims Act? Why or why not?