Term
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Definition
| a list of allowed amounts for all services and procedures payable by the insurance company |
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Term
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Definition
| two terms that mean the same thing as an indemnity plan |
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Term
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Definition
| a health insurance plan funded by the government |
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Term
| Centers for Medicare and Medicaid Services |
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Definition
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Term
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Definition
| a government agency that oversees the Medicare and Medicaid programs |
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Term
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Definition
| a government health insurance plan primarily covering persons aged 65 and older |
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Term
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Definition
| a government plan for financially indigent people |
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Term
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Definition
| services performed at a facility where the patient stays less than 24 hours and is not admitted to the facility |
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Term
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Definition
| Physician and outpatient services are covered by Medicare part ____. |
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Term
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Definition
| a person who has Medicare coverage |
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Term
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Definition
A person is eligible for Medicare if:
a) they are 65 years of age or older
b) they are disabled
c) they have end-stage renal disease
d) they have Medicare through spouse
e) all of the above
f) a and b
g) all but c
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Term
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Definition
| T or F: The rules of eligibility for Medicaid are national and not determined by the individual states. |
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Term
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Definition
A patient's Medicare claim number is:
123-45-6789A. When entering it on claims, you do not include the letter at the end--T or F? |
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Term
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Definition
| the Medicare plan in which reimbursement for most services and procedures is paid at 80 percent of the allowed amount |
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Term
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Definition
| a company that has contracted with CMS to pay Part B claims |
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Term
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Definition
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Term
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Definition
| a company that contracts with CMS to pay Medicaid claims |
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Term
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Definition
| a category listing requirements for a person to be covered by a specific plan |
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Term
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Definition
| a health insurance plan that includes financing, management, and delivery of health care services |
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Term
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Definition
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Term
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Definition
| a physician or other health care provider who is responsible for a patient's main health care |
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Term
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Definition
| a physician who specializes in a particular area of medicine |
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Term
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Definition
| medications prescribed by a physician or other licensed prescriber |
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Term
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Definition
| an encounter in the emergency room |
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Term
| health maintenance organization |
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Definition
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Term
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Definition
| a prepaid medical service plan that provides services to plan members |
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Term
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Definition
| medical care sought from participating providers within a managed care plan |
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Term
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Definition
| medical care sought from nonparticipating providers; those providers who have not contracted with specific managed care plans |
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Term
| preferred provider organization |
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Definition
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Definition
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