Certified Revenue Cycle Representative (CRCR) Practice Exam

Which payers are specifically liable for payment for Medicare fee-for-service patients?

1. Only Medicare and Medicaid

2. Public health service programs and Federal grant programs

3. Private insurance companies

4. Only veterans affairs programs

The correct answer is: Public health service programs and Federal grant programs

The correct choice identifies that public health service programs and federal grant programs have a specific liability for payment concerning Medicare fee-for-service patients. Medicare fee-for-service is a federal program that provides health insurance for individuals aged 65 and older, as well as certain younger individuals with disabilities or specific diseases. Public health service programs, which include a variety of services funded by the federal government, may have overlapping responsibilities with Medicare, particularly in transitional care or specific populations that qualify for both Medicare and additional health services. Federal grant programs also contribute to the healthcare coverage landscape and can provide resources for services that align with Medicare coverage, especially in public health initiatives or targeted healthcare services. In contrast, the other options are limited in scope regarding their relationship with Medicare fee-for-service. While private insurance companies may cover some services not reimbursed by Medicare, they are not the primary payers responsible for Medicare patients. Similarly, veterans affairs programs primarily serve veterans and do not cover traditional Medicare fee-for-service patients. Although Medicaid is a payer in certain contexts, its role is not solely to cover costs for Medicare fee-for-service patients, but rather in unison with Medicare for dual-eligible individuals.