Learning Outcomes

List the eligibility requirements for Medicare program coverage.

Describe the coverage provided by each of the four parts of the Medicare program.

Discuss medical and preventive services that are covered or excluded under Medicare Part B.

Discuss the billing rules governing Medicare participating providers.

Explain the calculations used to determine nonparticipating provider payments for assigned and unassigned claims under Medicare.

Describe the features of the Original Medicare Plan.

Discuss the features and coverage offered under Medicare Advantage plans.

Discuss Medigap insurance plans, and explain the coverage they offer.

Discuss the Medicare Medical Review (MR) Program.

Prepare correct Medicare primary claims.