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not medically necessary
Even if it is preapproved, a medical treatment may be denied reimbursement if it is
A specialized supplemental insurance policy devised for the Medicare beneficiary that covers the deductible and copayments typically not covered under the main Medicare policy, written by a nongovernmental third party payer
A physician who contracts with an HMO or other insurance company to provide services and who has agreed to accept a plan's payment for services to subscribers
Automobile Insurance Carrier
When a Medicare patient is injured in an automobile accident and the car is covered by liability isnurance, the insurance claim is sent to the
In the Medicare program, the monthly fee that enrollees pay for Medicare Part B medical insurance
An organization under contract to the government that handles claims under Medicare Part A
Time Limit for Filing A Claim
The end of the calendar year after the fiscal year when services are furnished
A physician who controls patient access to specialists and diagnostics testing services is called a
Congress passed an Act which requires most employers to offer an HMO alternative plan to their employees
Categorically Needy and Medically Needy are terms used with which health care reimbursement program
A fee that Medicare decides the medical service is worth, which may or may not be the same as the actual amount billed
The document detailing services billed and describing payment determinations issued to providers of the Medicare and Medicaid programs
A system of payment used by managed care plans in which physicians and hospitals are paid a fixed amount for each patient enrolled over a stated period of time, regardless of the type and number of services provided
Because the federal government sets minimum requirements, states are free to enhance the Medicaid program
Quality Improvement Organization
An organization of licensed doctors of medicine or osteopathy actively engaged in the practice of medicine or surgery, who evaluate other physicians about quality of professional care, as well as other factors according to federal guidelines.
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