The practice of billing patients for any balance left after deductibles, coinsurance, and insurance payments have been made.
A term used to describe low income families, pt's getting SSI, pregnant women, infants and children with incomes less that a specific percent of the federal poverty level.
The healthcare provider bills and collects from liable third parties before sending the claim to Medicaid.
The amount of income left over after eliminating all items that are not considered income, and applying all appropriate exclusions to the items that are considered income.
Federal Poverty Level
Income standards that are updated annually, and that serve as one of the eligibility factors for various state and federal assistance programs.
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 medical coverage.
Certain basic services that must be offered to the categorically needy population in any state Medicaid program.
Medical procedures, services, 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.
Payer of last resort
After all other available third party resources meet their legal obligation to pay claims, the Medicaid program pays for the care of an individual eligible for Medicaid.
Program for all inclusive care for the elderly.
When one state allows Medicaid beneficiaries from other states to be treated in its medical facilities.
Paper or electronic form sent by Medicare to the service provider that explains how payment was determined for a claim.
Specified Low Income Medicare Beneficiaries
Beneficaries with resources similar to Qualified Medicare Beneficiaries, but with slightly higher incomes.
Depleting private or family financies to the point where the individual or family becomes eligible for Medicaid assistance
Program that allows states to expand their Medicaid eligibility guidelines to cover more categories of children.
Supplemental Security Income
A program that provides federally funded cash assistance to qualifying elderly and disabled poor.
Temporary Assistance for Needy Families
A federaly-state cash assistance program for poor families, typically headed by a single parent.