Miscellaneous
This form is used to submit charges for outpatient services to health insurance companies
What is CMS 1500
A written recommendation to a specialist
What is referral
The age a patient becomes eligible for Medicare
What is 65
How many MCO'S does Medicaid have
What is four
Requirement to qualify for Medicaid
What is low income
Assigning a code that deliberately results in higher payment
What is upcoding
This written statement from an insurance company that summarizes the costs of a medical service or treatment
What is an Explanation of Benefits (EOB)
Medicare allows this amount of time for providers to bill claims
What is 365 days
This contains important information about the patient's insurance details needed to verify eligibility
What is an insurance card
How is Medicaid funded
What is federal and state government
Law states that physicians are not allowed to refer patients to a facility with whom they have a financial relationship
What is Stark Law
The amount of money that you pay before your insurance company starts paying for covered expenses
What is deductible
This Medicare plan is offered by private insurance companies, often having extra benefits included
What is Medicare Part C or Medicare Advantage
The Medicaid MCO's for Nevada
What is Anthem Medicaid, Silver Summit, HPN, Molina
What does CMS stand for
What is Centers for Medicare and Medicaid Services
Doctor's visits that help prevent or detect serious diseases and medical problems before they become major, often allowed once per year
What is preventive care
Process of requesting approval for a service or procedure by providing medical history to the insurance
What is preauthorization
A program created to assist with amounts left over after Medicare pays
What is Medicare Supplement or Medigap
The private health insurance company that contracts with states to provide Medicaid health care services
What is Managed Care Organization (MCO)
This type of Medicaid program provides health insurance to pregnant women and children in families with incomes up to a certain threshold, often higher than the regular Medicaid eligibility limits.
What is the Children's Health Insurance Program (CHIP)
Reviewing claims for accuracy and completeness
What is auditing
When someone intentionally deceives an insurance company or agent to receive money or benefits they are not entitled to
What is fraud
When a claim is automatically sent to the secondary insurance
What is crossover claim
The audit program that reviews Medicaid claims, and identifies overpayments
What is Medicaid Integrity Contractor (MIC)
The annual income threshold below which a household is considered to be in poverty
What is Federal Poverty Level (FPL)