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24 Cards in this Set
- Front
- Back
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a period of time during which benefits are paid under the policy |
BENEFIT PERIOD |
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a person enrolled in a health insurance plan, an insured (doesn't include dependents of the insured) |
ENROLEE |
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conditions for which the insured has received diagnosis, advice, care, or treatment during a specific time period prior to the application for health coverage |
PRE-EXISTING CONDITIONS |
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the money paid to the insurance company for the insurance coverage |
PREMIUM |
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fully insured or currently insured, depending on the number of coverage credits earned |
SOCIAL SECURITY DISABILITY INSURED STATUS |
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a period of time that must pass after a loss occurs before the insurer start paying policy benefits |
WAITING PERIOD |
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the amount a physician or supplier actually bills for a particular service or supply |
ACTUAL CHARGE |
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care that is provided at an ambulatory center. these are surgical services performed at a center that does not require a hospital stay unlike inpatient hospital surgery |
AMBULATORY SURGICAL SERVICES |
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the amount Medicare determines to be reasonable for a service that is covered under Part B of Medicare |
APPROVED AMOUNT |
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the physician of a medical supplier agrees to accept the Medicare - approved amount as full payment for the covered services. |
ASSIGNMENT |
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Organizations that process claims that are submitted by doctors and suppliers under Medicare |
CARRIERS |
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the port of Medicare's approved amount that the beneficiary is responsible for paying |
COINSURANCE |
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outpatient services recieved from a Medicare participating comprehensive outpatient rehab facility |
COMPREHENSIVE OUTPATIENT REHAB FACILITY SERVICES |
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the amount of expsense a beneficiary must first incur before Medicare begins payment for covered services |
DEDUCTIBLE |
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medical equipment such as oxygen, wheelchairs, and other medically necessary equipment that a doctor prescribes for use in the home |
DURABLE MEDICAL EQUIPMENT |
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the difference between the Medicare - approved amount for a service or supply and the actual charge |
EXCESS CHARGE |
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organizations that process inpatient and outpatient claims on individuals by hospitals, skilled nursing facilities, home health agencies, hospice and certain other providers of health services |
INTERMEDIARIES |
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the max amount a physician may charge a Medicare beneficiary for a covered service if the physician does not accept assignment |
LIMITING CHARGE |
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doctors of suppliers who may choose whether or not to accept assignment on each individual claim |
NONPARTICIPATING |
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medically necessary outpatient physical and occupational therapy or speech pathology services prescribed by a doctor or therapist |
OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY AND SPEECH PATHOLOGY SERVICES |
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provides a pap smear to screen for cervical cancer once every 2 years |
PAP SMEAR SCREENING |
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a program of outpatient mental health care |
PARTIAL HOSPITALIZATION FOR MENTAL HEALTH TREATMENT |
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doctors and suppliers who sign agreements to become Medicare participating (i.e. they have agreed in advance to accept assignment on all Medicare claims) |
PARTICIPATING DOCTORS OR SUPPLIERS |
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groups of practicing doctors and other health care professionals who are paid by the gov't to review the care given to Medicare patients |
PEER REVIEW ORGANIZATIONS |
