1. Form used to notify patients in advance that a service may not be covered ant the patient may be responsible.
    ABN ( Advance Beneficiary Notice)
  2. The amount an insurance carrier deems reasonable for the billed charges.
    Approved Amount
  3. A claim form that directs payment to the provider/supplier.
    Assigned Claims
  4. 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
  5. Process to ensure that Medicare reimburses providers based only on cost associated with patient care.
  6. A person eligible to receive insurance benefits.
  7. 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)
  8. The Medicare co-pay paid by the patient for services. It is sometimes referred to as a copayment.
  9. The amount that must be paid by a beneficiary before an insurer begins to pay for medical services.
  10. Classification of diagnoses used to determine hospital payment for Medicare inpatients.
    Diagnostic-Related Groups (DRG)
  11. A physician's listing of all reimbursement fees for all procedures performed in the practice.
    Fee Schedule
  12. A ten to eleven digit number assigned by Medicare to its beneficiaries.
    HICN - (Health Insurance Claim Number)
  13. Provides health coverage for the categorically needy.
  14. These are health care choices such as HMO's. Part C of the Medicare program.
    Medicare Managed Care Plans
  15. Health insurance policies sold by private companies, designed to supplement or fill in the gaps between Medicare and the patient.
  16. 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
  17. 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
  18. A dollar amount the insured person pays for insurance coverage.
  19. Paper summarized statement for providers including payments/rejections for one or more beneficiaries.
    Remittance Notice
  20. A system that calculates physician reimbursement for services using relative value units.
    Resource-Based Relative Value System/Scale (RBRVS)
Card Set
Medicare Insurance Terms for Final