Medical Insurance Terms-Winter 1-17
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each of the black spaces below before clicking
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| ABN-Advance Beneficiary Notice | Form used to notify patients in advance that a service may not be covered and the patient may be responsible
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| Actual Charge | The amount a physician or supplier actually bills a patient for a particular service or supply
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| Appeal | complaint beneficiaries make if they disagree with any decision about their health care services
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| Appellant | an individual who appeals a claim decision.
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| Approved Amount | The amount an insurance carrier deems reasonable for the billed charges.
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| Assigned Claims | a claim form that directs payment to the provider/supplier.
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| Assignment of Benefits | Authorization for the insurance company to send insurance payments directly to the health care provider, also, an agreement with Medicare that the provider will accept the remittance as full payment.
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| Audit | process to ensure that Medicare reimburses providers based only on cost associated with patient care
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| Beneficiary | a person eligible to receive insurance benefits
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| Claim | request for payment for Medicare benefits or services rendered by a provider.
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| CMS | Ceters for Medicare and Medicaid Service-administers and oversees the medicare program and a portion of the state Medicaid program
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| COB-Coordination Of Benefits | a program for determining which health insurer pays for services first when a beneficiary is covered by more than one health care plan.
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| Co-Insurance | The medicare co-pay paid by the patient for services. it is sometimes referrred to as a co-payment
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| CPT-Current Procedureal Terminology | system of uniformed medical procedure codes to identify specific health care services
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| Deductible | the amount that must be paid by a beneficiary before an insurere begins to pay for medical services
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| Diagnostic-Related Groups (DRG) | classification of diangoses used to determine hospital payment for medicare inpatients
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| ESR-End Stage Renal Disease | Kidney failure that is severe enough to require lifetime dialysis or kidney transplant
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| Utilization Review | review of individual cases by a committee to ensure services are medically necessary and to study how providers use medical resources
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Created by:
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