Medical Insurance Ch 10 Medicare

Medicare form used to inform a patient that a service to be provided is not likely to be reimbursed by the program.

Health plan; also known as insurance company, payer, or third-party payer.

Federal law establishing standards for laboratory testing peerformed in hospital-based facilities, physicians' office laboratories, and other locations; administered by CMS (Centers for Medicare and Medicaid Services)

Medicare's master patient/procedural database.

Government contractor that processes claims for government programs; for Medicare, the fiscal intermediary (FI) processes Part A claims.

Medicare defined geographical area offering participation bonuses to physicians.

Term for services al allied health professionals, such as nurses, technicians, and therapists, provided under the physician's direct supervision that may be billed under Medicare.

Medicare benefit of a preventive visit for new beneficiaries.

In Medicare, the highest fee (115 percent of the Medicare Fee Schedule) that nonparticipating physicians may charge for a particular service.

Notices sent to physicians to contain detailed and updated information about the coding and medical necessity of a specific Medicare service.

A payer's procedures for ensuring that providers give patients the most appropriate care in the most cost-effective manner.

The Medicare health savings account program.

New entities assigned by CMS to replace Part A fiscal intermediaries and the Part B carriers; also known as A/B MACs, they handle claims and related functions for both Parts A and B within specific multistate jurisdictions. DME MACs handle claims for durable medical equipment, supplies, and drugs billed by physicians.

Medicare plans other than the Original Medicare Plan.

Insurance identification card issued to Medicare beneficiaries.