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Benefit Period

A period of time during which payments for Medicare inpatient hospital benefits are available. Begins the first day an enrollee is given inpatient hospital care and ends when the enrollee has not been an inpatient for 60 consecutive days

Categorically Needy

Aged, blind, or disabled individuals or families and children who meet financial eligibility requirements for Aid to Families with Dependent Children, Supplemental Security Income, or and optional state supplement

Balance Billing

A statement sent to the patient after his or her insurance company has paid its portion of the claim

Ordering Physician

The physician ordering non-physician services for a patient when an insurance claim is submitted by a non-physician supplier of services

Point of Service Machine

Machine that allows the user to verify coverage in seconds and is available for several states

Medicaid (Medi-Cal)

A federally aided, state-operated, and state-administered program that provides medical benefits for certain low-income persons in need of health and medical care

Payer of Last Resort

The principle that MEDICAID pays last on a claim when a patient has other insurance coverage in place

Permanent Disability

An illness or injury expected to continue for the lifetime of the injured worker that prevents the person from performing the functions of his or her regular occupation, therefore impairing his or her earning capacity

Temporary Disability

The recovery period after a work-related injury during which the employee is unable to work and the condition has not stabilized

Doctor's First Report of Occupational Injury or Illness Form

Legal document that accompanies the CMS-1500 form which is done once the physician has seen the injured person. Failure to file the report can be a misdemeanor

Waiting Period

For disability insurance, the initial period of time when a disabled individual is not eligible to receive benefits even though unable to work; for workers' compensation, the days that must elapse before workers' compensation weekly benefits become payable

Urgent Care

Medically necessary treatment that is required for illness or injury that would result in further disability or death if not treated immediately

Covered Services

Specific services and supplies for which Medicaid will provide reimbursement; these consist of a combination of mandatory and optional services stated in the plan

Correct Coding Initiative

Federal legislation that attempts to eliminate unbundling or other inappropriate reporting of procedural codes for professional medical services rendered to patients

Crossover Claims

A bill for services rendered to a patient receiving benefits simultaneously from Medicare and Medicaid or from Medicare and a Medigap plan

Armed Services Disability

A disability occurring or aggravated while the patient is in military service


An amount owed on a credit transaction

Child Health and Disability Prevention Program (CHDP)

A program of prevention, early detection, and treatment of welfare children (younger than 21 years old)

Comprehensive Perinatal Services Program (CPSP)

A program for pregnant women

Centers for Medicare and Medicaid Services (CMS)

Formerly known as the Health Care Financing Administration. Divides responsibilities among three divisions: The Center for Medicare Management, the Center for Beneficiary Choices, and the Center for Medicaid and State Operations

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