in the Medicare program, one who is eligible to receive Medicare benefits for medical coverage or illness or injury or for death benefits.
correct coding initiative CCI
Bundling edits created by CMS to combine various component items with a major service or procedure.
an organization (private or public) that provides pain relief, symptom management, and support services to terminally ill patients and their families.
request from an insurance company for additional information required to process a claim for payment.
a physician who substitutes for another physician who is out of the office for an extended period of time.
a national health insurance program for persons over the age of 65 and qualified disabled or blind persons regardless of income, administered by CMS.
medicare part A
a national health insurance program for persons over the age of 65 and qualified disabled or blind persons regardless of income, administered by CMS to cover the cost of hospitalizations and nursing facility charges.
medicare part B
an elective coverage program offered by CMS for aged and disabled patients to provide benefits for physician and other medical services as part of the medicare program.
medicare part C
a medicare advantage program that combines part A and B, and sometimes part D (prescription drugs).
medicare part D
program that helps pay for outpatient prescription drugs and may help lower the costs of prescription drugs and help protect against higher costs in the future.
a specialized insurance policy for Medicare beneficiaries that pays deductibles and co-payment amounts not covered by the medicare program.
the amount the insured has to pay toward the amount allowed by the insurance company for services.
a form of prepayment in which a provider agrees to furnish services to members of a particular insurance program for a fixed fee.
third party payer
a carrier that has an agreement with an individual or organization to provide health care benefits.
an ongoing condition that exists with another condition for which the patient is receiving treatment.