The practice of billing patients for any balance left after deductibles, coinsurance, and insurance payments have been made.
Typically used to describe low income families with children, individuals receiving Supplemental Security Income, pregnant womenm, infants, and children with incomes less than a specified percent of the federal poverty level and qualified medicare beneficiaries.
A commercial insurer or agent that contracts with the Department of Health and Human Services for the purpose of processing and administering Part A Medicare claims for the reimbursement of healthcare coverage. Also may provide consultative services or serve as a center for communication with providers and make audits of providers' needs.
Medical services, procedures, or supplies that are reasonable and necessary for the diagnosis or treatment of a patient's medical condition, in accordance with the standards of good medical practice, performed at the proper level, and provided in the most appropriate setting.
How the decision was made regarding the payment of an insurance claim.
The duration of time during which a medicare beneficiary is eligible for Part A benefits for services incurred in a hospital or a skilled nursing facility (SNF) or both. A benefit period begins the day and individual is admitted to a hospital or an SNF and ends when the beneficiary has not received care in a hospital or SNF for 60 consecutive days.
drugs or medicinal preparations obtained from animal tissue or other organic sources
An explanation that a local coverage decision does not cover a certain item or service
Depleting private or family finances to the point where the individual or family becomes eligible for Medicaid assistance.
Patients who are eligible for Medicaid and Medicare coverage (see Medi-Medi)