Glossary
Someone who is the subscriber of an insurance policy or plan.
What is Beneficiary?
Clinical Laboratory Improvement Amendment
What is CLIA?
Helps pay the cost Original Medicare doesn't cover
What is Medigap?
Care provided to the chronically ill or disabled in a nursing facility or rest home
What is Long Term Care?
Fee schedule for physician payments; Limits on the amount non-participating providers can charge Medicare beneficiaries
What is Resource Based Relative Value Scale?
Occurs when patients pay for a portion of healthcare costs not covered by health insurance. Examples include deductible/coinsurance/copayments.
What is Cost-Sharing?
Anti-Dumping Statute
What is EMTALA?
Stand-alone insurance policy that covers medications
What is Part D?
Written or oral, the patient agrees to the treatment outlined.
What is Actual or Expressed Consent?
What is a Deductible?
The method for determining which insurance company is primarily responsible for payment when a patient is covered under more than one insurance plan.
What is Coordination of Benefits?
Purposely billing for services that were never given or to bill for a service that has a higher reimbursement than the service produced.
What is Fraud?
Begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital.
What is Benefit Period?
A legal document and clinical tracking tool
What is a Patient Medical Record?
What is Medicaid?
Payment model where services are unbundled and paid for separately.
What is Fee for Service?
Activated when a patient is incapacitated
What is a Advanced Directive?
To sustain the provision of healthcare for the nation's elderly and disabled by shifting costs to private insurers and other payers
What is Medicare Secondary Payer?
Patient's permission to render services
What is Consent?
The expert on Medicaid, Medicare, and Private Insurance eligibility guidelines
What is the Benefits Coordinator?
The amount a provider agrees to accept as full payment for health care services because of a contract that exists between the provider and insurer.
What is Approved Amount?
Governs Patient Confidentiality
What is the Privacy Act of 1974?
A physician who orders non-physician services for a patient such as a diagnostic x-ray
What is a Ordering Physician?
What is Scheduling Process?
Standardizes EPHI over the internet
What is Transaction Rule?