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Risk Adjustment Medicare and Commercial90016710416Transform your thinking about documentation and codingIntroductionIn a time of continual regulatory reform and the evolution of payer/provider reimbursement
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Medicare is a federal health insurance program for people who are 65 or older, as well as younger individuals with certain disabilities. Commercial insurance refers to private health insurance plans offered by companies.
Healthcare providers, facilities, and suppliers who participate in Medicare or accept commercial insurance are required to file medicare and commercial.
Medicare and commercial claims can be filled out and submitted electronically through the Centers for Medicare & Medicaid Services (CMS) website or through a clearinghouse.
The purpose of medicare and commercial is to reimburse healthcare providers for services rendered to eligible beneficiaries and ensure that they are paid accurately and timely.
Information such as patient demographics, diagnosis codes, procedure codes, dates of service, and provider information must be reported on medicare and commercial claims.
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