Insurance- Medicare Insurance Terms 1-17
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| ABN- Advance Beneficiary Notice | form used to notify patients in advance that a service may not be covered and the patient may be responsible.
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| Actual charge | the amount a physician or supplier actually build a patient for a particular service or supply
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| Appeal | complaint beneficiaries make if they disagree with any decision about their health care services.
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| appellant | an individual who appeals a claim decision.
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| approved amount | the amount and insurance carrier deems reasonable for the billed charges.
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| assigned claims | a claim form that directs payment to the provider/supplier.
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| assignment of benefits | authorization for the insurance company to send insurance payments directly to the healthcare provider also, an agreement with Medicare that the provider will accept the remittance as full payment.
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| Audit audit | process to ensure that Medicare reimburses providers based only on costs associated with patient care.
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| Beneficiary | a person eligible to receive insurance benefits
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| claim | request for payment of Medicare benefits or services rendered by a provider.
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| CMS -Centers for Medicare and Medicaid Services | administers and oversees the Medicare program and a portion of the state Medicaid program
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| COB- coordination of benefits | a program for determining which health insurance pays for services first when a beneficiary is covered by more than one health care plan.
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| coinsurance | d Medicare copay paid by the patient for services. It is sometimes referred to as a copayment.
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| CPT current Procedural Terminology | system of uniforms medical procedure codes to identify specific health care services.
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| Deductible | the amount that must be paid by a gun official Harry before an insurer begins to pay for medical services
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| diagnostic related groups DRG | classification of diagnosis used to determine hospital payment for Medicare inpatients
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| ESR end stage renal disease | kidney failure that is severe enough to require lifetime dialysis or a kidney transplant.
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