Form used to notify patients in advance that a service may not be covered ant the patient may be responsible.
ABN ( Advance Beneficiary Notice)
The amount an insurance carrier deems reasonable for the billed charges.
Approved Amount
A claim form that directs payment to the provider/supplier.
Assigned Claims
Authorization for the insurance company to send insurance payments directly to the health care provider also, an agreement with Medicare that the provider will accept the remittance as full payment.
Assignment of Benefits
Process to ensure that Medicare reimburses providers based only on cost associated with patient care.
Audit
A person eligible to receive insurance benefits.
Beneficiary
A program for determining which health insurer pays for service first when a benificiary is covered by more than one health care plan.
COB ( Coordination of Benefits)
The Medicare co-pay paid by the patient for services. It is sometimes referred to as a copayment.
Co-Insurance
The amount that must be paid by a beneficiary before an insurer begins to pay for medical services.
Deductible
Classification of diagnoses used to determine hospital payment for Medicare inpatients.
Diagnostic-Related Groups (DRG)
A physician's listing of all reimbursement fees for all procedures performed in the practice.
Fee Schedule
A ten to eleven digit number assigned by Medicare to its beneficiaries.
HICN - (Health Insurance Claim Number)
Provides health coverage for the categorically needy.
Medicaid
These are health care choices such as HMO's. Part C of the Medicare program.
Medicare Managed Care Plans
Health insurance policies sold by private companies, designed to supplement or fill in the gaps between Medicare and the patient.
Medigap
A physician who has not entered into a written agreement with an insurance copany to accept the plan's fee for services rendered.
Non-Participating Physician
A physician who has entered into a written agreement with an insurance company to accept the plan's fee for service rendered as payment in full.
Participating Physician
A dollar amount the insured person pays for insurance coverage.
Premium
Paper summarized statement for providers including payments/rejections for one or more beneficiaries.
Remittance Notice
A system that calculates physician reimbursement for services using relative value units.
Resource-Based Relative Value System/Scale (RBRVS)