Medicare Codes Clarified
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Sorting through the jumble of information, codes and prices when dealing with Medicare can be frustrating for many people, leading to unexpected expenses and confusion. At times one can use a dictionary to decipher precisely what a procedure or office visit cost. If you are on Medicare it can be helpful to understand the codes as they relate to your care.
One must first understand the difference between a CPT (current procedural terminology) code and a HCPCS (healthcare common procedure coding system) code.
CPT codes and HCPCS codes are actually very similar, they are both series of codes to determine the cost of procedures and treatments. The difference is that one (CPT) is used for people who aren’t on Medicare, and the other (HCPCS) is used solely for people who are on Medicare.
There are many different types of Medicare codes, but all doctors and practitioners will use the same ones for each service or procedure. This ensures that everyone is getting charged the right amount for the right services under Medicare, no matter who or where you are. Pricing will varying depending on what service, procedure or medicine that you receive. Common everyday procedures etc will be cheaper due to Medicare subsidy, and the codes will ensure you are being charged correctly.
Where To Find Medicare Codes
You can find a copy of Medicare codes at your healthcare providers premises or you can check them online at www.cms.gov. Your billing statement will have a code next to the amount charges and amount covered. It is wise to make a habit to check each statement or invoice you receive from a provider or Medicare to ensure the appropriate code has been applied. You will see a five digit number listed next to each service being charged to Medicare, check that the code attached is the correct one for the service you received. This will avoid any wrong billing or nasty surprises should coverage for a procedure be contested.
It is important that you actively take charge of this as HCPCS codes are frequently updated to reflect new payment schedules and you want to be sure you are being charged the correct amount.
ACA And Medicare
Since the introduction of the Affordable Care Act (ACA) or Obamacare insurance, many people on Medicare are wondering if it will affect their insurance. In general the answer is yes, but thus far has been a positive. Medicare patients will see a rise in care provided and theoretically pay less for prescriptions.
Each year the Center for Medicare and Medicaid Services (CMS) determines the coverage afforded those who chose to buy Medicare Advantage Plans. In February 2014 the CMS recommended decreasing the amount by five plus percent for seniors purchasing Medicare Advantage Plans. However after further analysis, the CMS revoked its’ recommendation. The CMS has approved a .04 increase of coverage for those who purchase a Medicare Advantage Plan. The increase will take effect January 1, 2015.
Using and managing your Medicare insurance does not need to be a complicated, confusing experience. With a little research and understanding, you can be sure you are making the most of the benefits of Medicare coverage available to you.
Fall enrollment for Medicare begins October 15th and ends December 7th. Any changes or tweaking to your Medicare coverage can be accomplished during open enrollment.
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