Medicaid is a healthcare insurance program structured as a federal-state partnership. Medicaid provides a suite of benefits and services through different programs aimed at specific populations. Medicaid helps to pay health care costs for individuals and families with low income and resources, people with disabilities, and elderly people.

In this seminar, attorney Eric Boughman addresses the fundamentals of Medicare, going through each of its parts, demographics, payments, and access. Eric also talks about the history of Medicaid, innovation, federal requirements for state Medicaid plans, benefits, expanded coverage and improved access under the ACA (Affordable Care Act) and SPA (State Plan Amendments), and waivers.

Attendees will gain insight into the essentials of each part of Medicare.

Medicare Part A provides coverage for attention received in hospitals and other inpatient facilities such as home health services and Skilled nursing facility (SNF) services. Medicare Part B delivers coverage for outpatient services such as physician services, medical supplies, appliances, and devices. Medicare Parts A and B are known as Original Medicare.

Medicare Part C is known as the Medicare Advantage (MA) program. It is managed by organizations that contract with the Centers for Medicare & Medicaid Services (CMS). This is an alternative to Original Medicare (Part A and Part B) for eligible people. There are several types of MA plans such as Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans.

Medicare Part D delivers prescription drug coverage, and it is also managed by organizations that contract with CMS. It can be a stand alone plan or part of a Medicare Advantage plan.

Eric will also discuss what beneficiaries pay under Medicare, services not covered, access to health care, how Medicare pays to physicians, Medicare funding, payments by type of service and future costs.

In considering Medicaid, Eric will discuss the history of Medicaid, how it was funded, the ACA expansion, and the capacity to innovate through the wide flexibility states have in managing Medicaid within guidelines. Attendees will also identify the federal coverage requirements for state Medicaid plans, state variety in benefits and state variety in groups covered.

Finally, we will discuss SPA and waivers. For each state there is a comprehensive Medicaid plan and to make an amendment, a state must receive approval from CMS. Attendees will also learn about beneficiary participation along with the provider participation and compensation

Learning Objectives:

• Knowing the Medicare background
• Identifying the parts of Medicare
• Knowing the demonstration projects
• Identifying the demographics of Medicare
• Understanding what beneficiaries pay under Medicare and coverage
• Understanding how Medicare pay physicians
• Knowing sources of Medicare revenue
• Identifying Medicare payments by type of service
• Understanding what drives Medicare spending
• Knowing the Medicaid overview
• Identifying the Medicaid Managed Care
• Knowing the Children’s Health Insurance Program
• Understanding how Medicaid is funded
• Understanding the expanded coverage under the ACA
• Understanding Medicaid and innovation
• Knowing federal requirements for state Medicaid plans
• Knowing the state variety in benefits and in groups covered
• Understanding the SPA and waivers
• Identifying the beneficiary participation
• Identifying the provider participation and compensation
• Understanding Medicaid and access
• Understanding ACA and improved access

Areas Covered in the Session

• Medicare overview and background
• Parts of Medicare
• Medicare payments and coverage
• Medicare funding
• Future costs
• History of Medicaid
• Expanded Coverage under the ACA
• Medicaid and innovation
• Federal requirements for state Medicaid plans
• State variety in benefits and in groups covered.
• SPA and waivers
• Beneficiary and provider participation and compensation
• Medicaid and access

Suggested Attendees

• Healthcare providers and staff.
• Hospital and healthcare facility administration.
• Vendors and contractors who work in the healthcare sector.
• Legal counsel and other professional advisors to healthcare providers
• Physician
• Nurses
• Physician Assistants
• Healthcare Billing and Coding Staff
• Credentialing and Enrollment Specialists
• Healthcare Administrative Personnel
• Clinic Managers Credentialing and Enrollment Specialists
• Healthcare Administrative Personnel
• Practice Managers
• Auditors
• Compliance Officers
• Medical record supervisors
• Health Information Management Administrators and Technicians
• Other Personnel Interested in Billing Privileges with the Medicare Program

About the Presenter