click below
click below
Normal Size Small Size show me how
Medicare Unit Vocab
Term | Definition |
---|---|
Medicare | federal health insurance [program created in 1965 as Title 18 of the Social Security Act (SSA). Managed by CMS (Centers for Medicare and Medicaid Services) |
benefit period | period of time that begins when an individual is admitted to a hospital or skilled nursing facility and ends 60 days after the discharge date; used to determine deductibles and co-payments for Medicare Part A |
Medicare Advantage | Manged care alternative to original Medicare FFS plan. Offering HMO/PPO style plans including Parts C and D. |
Medicare Administrative Contractor | Independent companies hired to process Medicare claims. Issue payments and claim decisions to providers and patients. Formerly known as fiscal intermediaries or insurance carriers |
limiting fee | maximum fee a provider may charge. For Medicare up to 15% above the Medicare Non-Par approved rate |
Medigap | supplemental plans designed by the federal government but sold by private commercial insurance companies to cover the costs of Medicare deductibles, co-payments, and co-insurance, which are considered "gaps" in medicare coverage. |
Medicare Fee Schedule | List of Medicare approved payment rates |
Medicare/ Medicaid Crossover Program | claims submitted to Medicare for Medicare/Medicaid beneficiaries, Medicare will pay the claim, apply a deductible/coinsurance or co-pay amount and then automatically forward the claim to Medicaid. Providers will not need to bill Medicaid separately |
Advance Beneficiary Notice | notice issued to patient prior to rendering of services when it is believed that Medicare will not cover the service that is planned. |
health insurance claim number | Medicare beneficiary ID number. The social security number of the wage earner followed by a one or two character alpha suffix |
Suffix category A | retired worker over 65 or disabled worker |
Suffix category B | spouse or former spouse |
Suffix category C | child (includes disable child or student) |
Suffix category D | deceased spouse |
Suffix category E | widowed mother |
Suffix category F | parent category for aged parents as dependents |
Suffix category H | disability claimant |
Suffix category W | disabled widow/widower |