Chapter 8 Medicare Terms Flashcards
(18 cards)
What is Actual Charge?
The amount a physician or supplier actually bills for a particular service or supply.
What are Ambulatory Surgical Services?
Care that is provided at an ambulatory center, which includes surgical services performed at a center that do not require a hospital stay.
What is Approved Amount?
The amount Medicare determines to be reasonable for a service that is covered under Part B of Medicare.
What does Assignment mean in Medicare?
The physician or a medical supplier agrees to accept the Medicare-approved amount as full payment for the covered services.
What are Carriers in the context of Medicare?
Organizations that process claims that are submitted by doctors and suppliers under Medicare.
What is Coinsurance?
The portion of Medicare’s approved amount that the beneficiary is responsible for paying.
What are Comprehensive Outpatient Rehabilitation Facility Services?
Outpatient services received from a Medicare participating comprehensive outpatient rehabilitation facility.
What is a Deductible?
The amount of expense a beneficiary must first incur before Medicare begins payment for covered services.
What is Durable Medical Equipment?
Medical equipment such as oxygen equipment, wheelchairs, and other medically necessary equipment that a doctor prescribes for use in the home.
What is an Excess Charge?
The difference between the Medicare-approved amount for a service or supply and the actual charge.
What are Intermediaries?
Organizations that process inpatient and outpatient claims on individuals by hospitals, skilled nursing facilities, home health agencies, hospices and certain other providers of health services.
What is a Limiting Charge?
The maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does not accept assignments.
What does Nonparticipating mean?
Doctors or suppliers who may choose whether or not to accept assignments on each individual claim.
What are Outpatient Physical and Occupational Therapy and Speech Pathology Services?
Medically necessary outpatient physical and occupational therapy or speech pathology services prescribed by a doctor or therapist.
What is Pap Smear Screening?
Provides for a pap smear to screen for cervical cancer once every 2 years.
What is Partial Hospitalization for Mental Health Treatment?
A program of outpatient mental health care.
Who are Participating Doctors or Suppliers?
Doctors and suppliers who sign agreements to become Medicare-participating and have agreed in advance to accept assignments on all Medicare claims.
What are Peer Review Organizations?
Groups of practicing doctors and other health care professionals who are paid by the government to review the care given to Medicare patients.
