Ch 8 Health Insurance Key Terms
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17 terms
Terms | Definitions |
|---|---|
 Balance Billing | The practice of billing patients for any balance left after deductibles, coinsurance, and insurance payments have been made. |
| Categorically needy | 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. |
| Cost avoidance | The healthcare provider bills and collects from liable third parties before sending the claim to Medicaid. |
| Countable income | 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. |
| Fiscal Intermedairy | 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. |
| Mandated services | Certain basic services that must be offered to the categorically needy population in any state Medicaid program. |
| Medically necessary | 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. |
| PACE | Program for all inclusive care for the elderly. |
| Reciprocity | When one state allows Medicaid beneficiaries from other states to be treated in its medical facilities. |
| Remittance advice | 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. |
| Spend down | Depleting private or family financies to the point where the individual or family becomes eligible for Medicaid assistance |
| SCHIP | 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. |
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