California Life and Health Insurance Practice Exam

Who would be most likely to submit a Medicare Part A claim?

1. Physician

2. Hospital

3. Pharmacy

4. Insurance Agent

The correct answer is: Hospital

The submission of a Medicare Part A claim is most commonly associated with hospital services. Medicare Part A primarily covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Therefore, the entity responsible for billing Medicare Part A for the services provided in a hospital setting is typically the hospital itself. Hospitals submit claims to Medicare for the services rendered to patients admitted under Medicare coverage. This process involves detailed documentation of the care given, including diagnoses and treatments provided during the hospital stay. Physicians, while they may bill separately under Medicare Part B for their professional services, do not handle claims for inpatient hospital care directly through Part A. Pharmacies primarily deal with claims under Medicare Part D, which pertains to outpatient prescription drugs, while insurance agents do not directly submit claims but rather help clients understand and navigate their coverage options. Therefore, the nature of the services and the billing procedures confirm that hospitals are the correct choice for submitting Medicare Part A claims.