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22 Cards in this Set
- Front
- Back
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Advance Beneficiary Notice of Noncoverage (ABN)
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Notice given to Medicare beneficiaries to convey that Medicare is not likely to provide coverage in a specific case.
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Accept Assignments
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Any physician who agrees to treat Medicaid patients also agrees to accept the established Medicaid payment for covered services as payment in full.
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Allowable Benefits
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The claims department also compares the fees the physician has charged with the benefits provided by the patient's health insurance policy.
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Advantages of Electronic Billing
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Fewer lost medical records, elimination of transcription costs, increased readability/legibility of charts, ease of chart access for multiple users, chart availability outside of office hours, increased access to patient education materials, decreased duplication of medical tests, more efficient records transfer, more efficient billing processes using electronic billing methods, and decreased need for storage space.
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Blue Cross Blue Shield (BCBS)
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A nationwide federation of nonprofit and for-profit service organizations that provide prepaid healthcare services to BCBS subscribers.
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Birthday Rule
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A rule that states that the insurance policy of a policyholder whose birthday comes first in the year is the primary payer for all dependents.
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Capitation
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A payment structure in which a health maintenance organization prepays an annual set fee per patient to a physician.
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Copayment
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A fixed or set amount paid for each healthcare or medical service; the remainder is paid by the health insurance plan.
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Deductible
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A fixed dollar amount that must be paid by the insured before additional expenses are covered by an insurer.
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Liability
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Covers injuries caused by the insured or that occurred on the insured's property.
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Medicare Part A & B
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The largest federal program, which provides health insurance for citizens aged 65 and older. Part A is the hospital benefit; Part B covers a portion of the allowed charges, usually 80%.
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Medicaid
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A health cost assistance program, not an insurance program. Designed for low-income, blind, or disabled patients; needy families; foster children; and children born with birth defects.
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Medicaid Eligibility
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Based on the patient's reported income and assets from the previous month.
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Predetermination
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The insurance plan informs the physician of the maximum amount they will pay for the procedure to be performed.
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Premium
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The basic annual cost of healthcare insurance.
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Resource-Based Relative Value Scale (RBRVS)
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The payment system used by Medicare. It establishes the relative value units for services, replacing the providers' consensus on usual fees.
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Subscriber
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The patient.
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Tricare
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(formerly known as CHAMPUS, or Civilian Health and Medical Program for Uniformed Services) is not a health insurance plan. Rather, it is a healthcare benefit for families of uniformed personnel and retirees from the uniformed services, including the Army, Navy, Marines, Air Force, Coast Guard, Public Health Service, and National Oceanic and Atmospheric Administration.
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Typical Insurance Claims are filed in how many days?
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Within 60 or 90 days from the date of service, while others, like Medicare, will allow up to a year for claim submission.
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Usual Fee
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Fee the Physicians charge for a non-covered service.
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Workers Compensation
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Covers employment-related accidents or diseases.
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Electronic Claim Submission
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Electronic Data Interchange (EDI) is the computer-to-computer exchange of business documents in a structured, mutually agreed upon data format.
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