Benefits
..... is the flat amount the member pays at the time of a medical service or to receive a medication.
What is A Copay
The point at which the patient leaves the hospital and either returns home or is transferred to another facility such as one for rehabilitation or to a nursing home. This may also involves the medical instructions that the patient will need to fully recover.
What is Discharge (Discharge Date)
An insurance paid by employers when an employee gets injured at work.
What is Workers Compensation
The agency within the Department of Health and Human Services that is responsible for the administration of the Medicare program, as well as the federal participation in the state Medicaid program.
What is Centers for Medicare and Medicaid Services (CMS)
Notification to an insurance company that payment of an amount if due under the terms of a policy.
What is A Claim
...... is a fixed amount of money the member has to pay before most, if not all, of the policy's benefits can be enjoyed.
What is A Deductible
The actual dollar amount charged by a physician or other provider for medical services rendered.
What is Charge Amount
This pays out money called a death benefit to a designated beneficiary when you die. You can name people, companies, or trusts as beneficiaries, and you can have more than one beneficiary who will split your death benefit in accordance with your instructions.
What Is Life Insurance
These Criteria need to be met in order to be on Medicare
What is Person age 65 or older, Disabled persons, and person with End Stage Renal Disease (ESRD) or otherwise known as Permanent Kidney failure
HIPPA is also known as the ___________ Act.
What is The Kennedy-Kassenbaum Act
....... expenses are what the member pays for health-related services above and beyond their monthly premium. Depending on the health plan, these expenses may include an annual deductible, coinsurance, and copayments for doctor visits and prescription drugs
What is An Out- Of - Pocket
A method of reimbursement to providers for each treatment or procedure performed. Payment may be made by an insurance company, patient, or government program such as Medicare or Medicaid.
What is Fee for Service
A type of insurance that offers more than health insurance and is financed by premiums.
What is Commercial Insurance
A claim form used by professionals to bill for services. Required by Medicare and generally used by private insurance companies and managed care plans
What is The CMS-1500
The act of manipulating people into performing actions or divulging confidential information, rather than by breaking in or using technical hacking techniques; essentially a fancier, more technical way of lying.
What is Social Engineering
This is the highest or total amount a health insurance company requires a member/subscriber to pay towards the cost of their health care.
Typically, after the member’s responsibilities are met for the benefit year, the insurance company will pay for 100% of all covered medical services.
What is the Maximum Out- Of- Pocket
Method of payment in which the provider is given a fixed dollar amount for each patient served, regardless of the actual number or nature of services rendered. It is also is expressed as a "per member per month" amount.
What is Capitation
This is intended to pay for the costs of medical care. Many people get this type of insurance through employers who subsidize premiums, meaning the employer pays the bulk of your premium, and you chip in a little with each paycheck.
What is Health Insurance
A joint Federal and state program that helps with medical costs for some people with low income and limited resources.
What is Medicaid
Licensed by the government to provide medical care, services, goods, and supplies to patients.
What is A Provider
These are services or supplies a health plan agrees to cover. Covered benefits and services differ from plan to plan. There are still costs that aren’t covered by health plans and are payable by the member, such as:
– Copayment
– Deductible
– Coinsurance
– Limitations/Maximums
– Non- covered Services
What is Benefits
The practice of a provider billing a patient for all charges not paid for by the insurance plan. (i.e. charges above the plan’s fee schedule). Most plans prohibit this except for allowed copay, coinsurance, and deductibles.
What is Balance Billing
A US federal government program that provides health insurance to people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients
What is Medicare
Comprises of Part A, Part B and or Part D and is usually offered by private insurance carriers such Aetna Human, Cigna ETC
What is Medicare Advantage Plans
An organization or agency, certified by Medicare whose is primarily engaged in providing pain relief to terminally ill people and their families
What is Hospice