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Carnegie Medicare in
Medicare insurance terms 18 to 34
| Term | Definition |
|---|---|
| fee schedule | a physician's listing of all reimbursement fees for all procedures performed in the practice |
| fiscal agent | fiscal agent and insurance company that processes and pays claims on behalf of a state Medicare carrier |
| H I can health insurance claim number | a 10 to 11 digit number assigned by Medicare to its beneficiaries |
| limiting charge | the highest amount a beneficiary can be charged for a covered service by non participating providers |
| Medicaid | provides health coverage for the categorically needy |
| Medicare | primarily for people older than 65 and others eligible for Social Security, Federal Insurance Program established in 1965 under the Social Security Act |
| Medicare managed care plans | these are health care choices such as HMOs Part C of the Medicare program |
| Medigap | health insurance policies sold by private companies, design to supplement or fill in the gaps between Medicare and the patient. |
| Non-assigned claim | a claim form which directs payment to the beneficiary |
| non participating physician | a position who has not entered into a written agreement with an insurance company to accept the plan's fee for services rendered |
| participating physician | a physician's who has entered into a written agreement with an insurance company to accept the Plan B for service rendered as payment in full |
| Premium | a dollar amount the insured person pays for insurance coverage |
| relative value studies RVs | relative values listed by health care procedure codes allows comparison of reimbursement for different codes |
| relative value unit RVU | the time that is multiplied by a monetary conversion factor to establish position payment for the resource-based relative value system or scale |
| remittance notice | paper summarized statement for providers including payments rejections for one or more beneficiaries |
| resource based relative value system scale RBRVS | a system that calculates position reimbursement for services using relative value units usual |
| usual, customary, and reasonable UCR | a method used by insurance carriers to establish provider payments based on the compendium of other like provider fee. |
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