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Med. Billing Terms#2

Medical Billing Terms#2-Winter Term

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