I
A short-term hospice inpatient stay for a terminally ill patient to give temporary relief to the person who regularly assists with home care of a patient.
What is respite care?
The process of paying claims submitted or denying them after comparing the claim to benefit and coverage requirements.
Adjudication
This was implemented by Medicare to identify procedures that are usually described by a single code or are inherent to another procedure.
Correct Coding Initiative
This is the term used for a claim that is transferred directly to the Medicaid program after Medicare payment has been made.
Crossover Claim
This is the term used for Medicare Advantage programs.
What is Medicare Part C?
This is a standalone prescription drug plan offered by insurance companies and other private companies providing drug coverage that meets standards established by Medicare.
What is Medicare Part D?
This program pays monthly income benefits to people (adults and children) with limited income and resources who are disabled, blind, or age 65 or older.
What is Supplemental Security Income?
Persons in need of financial assistance or whose income and resources will not allow them to pay for the costs of medical care.
What is categorically needy?
These programs were developed by state Medicaid programs designed to help low-income individuals with out-of-pocket costs for Medicare.
What is a Medicare Savings Programs
This is a cost-sharing requirement under a health insurance policy in which the insured will assume a percentage of the costs for covered services.
What is coinsurance?
Federal legislation that prevents the depletion of resources of the living spouse from being impoverished by his or her spouse's institutionalization.
What is the Spousal Impoverishment Protection Law?
This is a measure of income issued every year by the Department of Health and Human Services found in the Federal Register; used to determine eligibility for certain Medicaid programs.
What is the Federal Poverty Level?
This is the amount the patient must pay each month before he or she can be eligible for Medicaid; also known as liability or spend down.
What is Share of Cost?
This is a government-sponsored program that provides military and nonmilitary hospital and medical services. It covers spouses and dependents of active service personnel, retired service personnel and their dependents.
What is TRICARE?
This is an amount on which TRICARE figures the patient's cost share for covered care. This is based on 75% to 80% of the allowable charge.
What is the Allowable Charge.
This is a TRICARE-authorized provider that has signed a contract with a regional TRICARE contractor.
What is a TRICARE network provider?
This is the maximum dollar amount that a member has to pay under TRICARE or CHAMPVA in any fiscal year or enrollment period.
What is a Catastrophic Cap?
This is a area defined by zip code in the TRICARE program.
What is a Catchment Area?
This program provides coverage for civilian health care providers to ADSMs (active duty service members) and non-TRICARE-eligible patients.
What is a Supplemental Healthcare Program in TRICARE?
This is an injury incurred by a service member while on active duty or incurred during reserve duty with a military unit.
What is a service-connected injury?