Term
| Advance Beneficiary Notice (ABN) |
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Definition
| Notice to a patient that services may be denied by Medicare and that the patient would be obligated to pay |
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Term
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Definition
| The amount insurance companies consider to be an appropriate fee for a given service |
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Term
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Definition
| A person who is eligible for coverage by government health policies |
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Term
| Centers for Medicare and Medicaid Services (CMS) |
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Definition
| The federal agency that administers the Medicare program and works with state governments to administer Medicare/Medicaid programs |
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Term
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Definition
| Health insurance claim form that has been completed correctly without any errors |
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Term
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Definition
| Most common health insurance claim form used to file claims for physicians services |
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Term
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Definition
| a fixed percentage of charges the patient must pay under a given insurance plan ex: 80/20,70/30 |
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Term
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Definition
| procedures to prevent duplication of payments by more than one insurance carrier |
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Term
| Current Procedural Terminology (CPT) |
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Definition
| codes that identify the services that were provided (office visit, consultation, surgeries) |
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Term
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Definition
| Amount that patients need to pay each calendar year before the insurance plan starts to pay benefits |
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Term
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Definition
| family member on a health plan |
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Term
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Definition
| medical procedure that is non-emergent but may benefit the patient |
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Term
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Definition
| schedule of fees for each procedure or service that physicians office's provide |
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Term
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Definition
| set fees for services established by a health care provider and paid for by the patient |
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Term
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Definition
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Term
| Health Maintenance Organization |
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Definition
| type of managed care plan that requires patients to choose a pcp |
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Term
| Managed Care Organization |
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Definition
| a form of health insurance intended to reduce costs, broken down into 3 major classifications of health insurance |
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Term
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Definition
| insurance designed for low income individuals |
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Term
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Definition
| The process of establishing a medical need for something |
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Term
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Definition
| Insurance for people age 65 and up, disabled or patients who have ESRD |
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Term
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Definition
| hospital insurance includes inpatient, home care, hospice and inpatient psych services |
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Term
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Definition
| Medical insurance, doctors visits, outpatient facilities like physical therapy and lab testing |
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Term
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Definition
| Managed care or advantage plan |
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Term
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Definition
| Prescription drug coverage |
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Term
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Definition
| Insurance for active duty and retired military personnel and their families |
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Term
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Definition
| Insurance for veterans with service related disabilities |
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Term
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Definition
| Insurance that covers employees injured in the workplace or off-site while conducting company business or suffering a workplace-related illness |
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Term
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Definition
| insurance that fills the gap in Medicare |
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Term
| National Provider Identifier |
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Definition
| Ten-digit identification number assigned to health care providers by the Centers for Medicare and Medicaid Services |
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Term
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Definition
| Type of managed care organization that allows you to choose between an HMO and a PPO |
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Term
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Definition
| A provider who refers patients to other providers for more specialized care and oversees and manages all aspects of patients health care |
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Term
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Definition
| Requirement to obtain prior approval before surgery and other procedures including medications |
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Term
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Definition
| Monthly payment for health insurance |
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Term
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Definition
| The insurance policy billed first for any health care services |
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Term
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Definition
| The insurance billed for the costs that are not covered by the primary payer |
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Term
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Definition
| The amount that patient pays that is determined by the insurance at the time of the visit |
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Term
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Definition
| A provider who has a contractual agreement with an insurance plan to render care to eligible beneficiaries and then bill the insurance carrier directly |
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