health ins.today 8&9
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10 terms
Terms | Definitions |
|---|---|
 balance billing | the practice of billing patients for any balance left after deductables,coinsurance and insurance payments have been made |
| medically necessary | 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. |
| categorically needy | 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. |
| dual eligibles | Patients who are eligible for Medicaid and Medicare coverage. |
| fiscal intermediary | 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. |
| adjudicated | How the decision was made regarding the payment of an insurance claim. |
| benefit period | The _________ is the duration of time during which a Medical beneficiary is eligible for Part A benefits for services incurred in a hospital or skilled nursing facility (SNF) or both. |
| biologicals | Drugs or medicinal preparations obtained from animal tissue or other organic sources. |
| denial notice | An explanation that a local coverage decision does not cover a certain item or service |
| spend down | Depleting private or family finances to the point where the individual or family becomes eligible for Medicaid assistance. |
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