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Carnegie Medicare in

Medicare insurance terms 18 to 34

TermDefinition
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.
Created by: ma2b
 

 



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