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13 Cards in this Set
- Front
- Back
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Abuse
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Misuse; excessive or improper use
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Adjustment
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Increases or decreases to patient accounts not due to charges incurred or payments received assignments
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Assignments of benefits
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Signing over of benefits by the beneficiary to another party
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Centers for Medicare and Medicaid services
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Hcfa. Fed. Agency w/ vs. dept. health & human services (DHHS) administers Medicare,Medicaid, & state children's health insurance program (SCHIP) administers (HIPPA) 1996 & clinical lab
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Copayment
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Payment required when seen by the provider
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Explanation of benefitsfiscal
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Insurance report that is sent with claim payments explaining the reimbursement of the insurance carrier
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Fraud
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Deliberate misrepresentation of facts
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med part A Ned
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Benefits covering inpatient hospital and skilled nursing facilities hospice care and blood transfusion
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Med part D
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Prescription drug coverage by Medicare
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Preauthorization
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Obtaining an insurance carriers consent to proceed w/ patient care and treatment
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Primary care provider
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Primary care provider all Care is coordinated through them
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Referal
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When a PCP refers a patient to a specialist
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Med part B
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Benefits covering out-patient hospital and health care provider services.
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