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Carnegie Medicare 1

Insurance- Medicare Insurance Terms 1-17

ABN- Advance Beneficiary Notice form used to notify patients in advance that a service may not be covered and the patient may be responsible.
Actual charge the amount a physician or supplier actually build a patient for a particular service or supply
Appeal complaint beneficiaries make if they disagree with any decision about their health care services.
appellant an individual who appeals a claim decision.
approved amount the amount and insurance carrier deems reasonable for the billed charges.
assigned claims a claim form that directs payment to the provider/supplier.
assignment of benefits authorization for the insurance company to send insurance payments directly to the healthcare provider also, an agreement with Medicare that the provider will accept the remittance as full payment.
Audit audit process to ensure that Medicare reimburses providers based only on costs associated with patient care.
Beneficiary a person eligible to receive insurance benefits
claim request for payment of Medicare benefits or services rendered by a provider.
CMS -Centers for Medicare and Medicaid Services administers and oversees the Medicare program and a portion of the state Medicaid program
COB- coordination of benefits a program for determining which health insurance pays for services first when a beneficiary is covered by more than one health care plan.
coinsurance d Medicare copay paid by the patient for services. It is sometimes referred to as a copayment.
CPT current Procedural Terminology system of uniforms medical procedure codes to identify specific health care services.
Deductible the amount that must be paid by a gun official Harry before an insurer begins to pay for medical services
diagnostic related groups DRG classification of diagnosis used to determine hospital payment for Medicare inpatients
ESR end stage renal disease kidney failure that is severe enough to require lifetime dialysis or a kidney transplant.
Created by: ma2b