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Med. Billing Terms#2
Medical Billing Terms#2-Winter Term
| Question | Answer |
|---|---|
| Fee Schedule | A physician's listng of all reimbursement fees for all procedues performed in the practice |
| Fiscal Agent | An insurance company that processes and pays claims on behalf of a state Medicare carrier |
| HICN-Health Insurance Claim Number | A ten to eleven digit number assigned by Medicate to its beneficiarie. |
| Limiting Charge | the highest amount a beneficiarycan be charged for a covered service by non-participating providers |
| Medicaid | Provides health coverage for the categorically needy |
| Medicare | primarily for people oldr than 65 and othrs 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 HMO's. Part C of the Medicare program |
| Medigap | Health insurance policies sold by private companies, designed 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 physician who has not enterted into a written agreement wit an insurance company to accept the plan's fee for services rendered |
| Participating Physician | A physician who has entered into a written agreement with an insurance company to acceptthe plan's fee 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 | The time that is multiplied by a monetarty conversion factor to establish physician 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 |
| Resourced-Based Relative Value System/Scale (RBRVS) | a system that calculates physician reimbursement for services using relative value units |
| Usual, Customary, and Reasonable (UCR) | a method used by insurance carriers to establish provider payments based on a compendium of other like provider fee. |
Created by:
d.holifield
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