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ACCEPTING ASSIGNMENT

1a

WHEN A PHYSIAN AGREES TOTREAT MEDICAID PATIENTSALSO AGREES TO ACCEPT THEESTABLISHED MEDICAIDPAYMENT FOR COVEREDSERVICES.

1b

ADVANCE BENEFICIARYNOTICE - ABN

2a

FORM GIVEN TO PATIENTS BYPROVIDER WHEN A

PROCEDURE/FEE FOR SERVICEWILL NOT BE COVERED BY

MEDICARE

2b

ALLOWED CHARGE

3a

THE AMOUNT THAT IS THEMOST THE PAYER WILL PAYANY PROVIDER FOR EACHPROCEDURE OR SERVICE. THEPAYERS PAYMENT IS BASED ONTHIS ALLOWED CHARGE

3b

ASSIGNMENT OF BENEFITS

4a

A FORM THE PATIENT SIGNS"ASSIGNING" OR ALLOWINGTHEIR HEALTH INSURANCE

BENEFITS TO BE PAIDDIRECTLY TO THE PROVIDER

4b

BENEFITS

5a

HEALTH CARE SERVICES YOUARE ENTITILED TO

5b

BIRTHDAY RULE

6a

A RULE THAT STATES THEINSURANCE POLICY OF A POLICYHOLDER WHOSE BIRTHDAYCOMES FIRST IN THE YEAR IS TOBE THE PRIMARY PAYER FORALL DEPENDENTS

6b

BLUE CROSS/BLUE SHIELD -BCBS

7a

BLUE CROSS BLUE SHIELD IS A NATIONWIDE FERERATION OF NONPROFIT ANDFOR PROFIT SERVICE ORGANIZATIONSTHAT PROVIDE PREPAID HEALTH CARESERVICES TO SUBSCRIBERS; BLUE CROSSCOVERS MEDICAL BILLS (DOCTOR;S VISITS)AND BLUE SHIELD COVERSHOSPITALIZATION

7b

CAPITATION

8a

A PAYMENT STRUCTURE INWHICH A HEALTH

MAINTENENCE ORGANIZATIONPREPAYS AN ANNUAL SET FEEPER PATIENT TO A PHYSICIAN

8b

CAPITATION(REIMBURSEMENT)

9a

THIS IS FIXED PREPAYMENT FOR EACHPLAN MEMBER IN CAPITATION CONTRACTSTHAT IS DETERMINED BY THE MANAGEDCARE PLAN THAT INITIATES CONTRACTSWITH PROVIDERS. THE PROVIDER LISTSTHE SERVICES AND PROCEDURES THATARE COVERED BY THE CAP RATE.

9b

CHAMPUS

10a

CIVILIAN HEALTH ANDMEDICAL PROGRAM FORUNIFORMED SERVICES.

10b

CHAMPVA

11a

WHAT IS THE CIVILIAN HEALTH AND MEDICALPROGRAM OF THE VETERANSADMINISTRATION. A TYPE OF INSURANCE THATCOVERS THE HEALTH CARE EXPENSES OFDEPENDENTS OF VETERANS WITH SERVICECONNECTED PERMANENT DISABILITIES. ALSOCOVERS THE SURVIVING DEPENDENTS OFVETERANS WHO DIE IN THE LINE OF DUTY ORAS A RESULT OF A SERVICE CONNECTEDDISABILITY

11b

CHARGE SLIP

12a

ORIGINAL RECORD OFSERVICES PERFORMED FOR APATIENT AND THE CHARGES

FOR THOSE SERVICES

12b

CLEARINGHOUSE

13a

A GROUP THAT TAKESNONSTANDARD MEDICALBILLING SOFTWARE FORMATSAND TRANSLATES THEM INTOTHE STANDARD EDI(ELECTRONIC DATAINTERCHANGE) FORMAT

13b

CMMS

14a

CENTERS FOR MEDICARE ANDMEDICADE SERVICES IS ACONGRESSIONAL AGENCY DESIGNEDTO HANDLE MEDICARE ANDMEDICAID INSURANCE CLAIMS. ITWAS FORMERLY KNOWN AS THEHEALTH CARE FINANCINGADMINISTRATION (HCFA)

14b

CMS 1500

15a

UNIVERSAL CLAIM FORM THATIS SUBMITTED TO INSURANCECARRIERS FOR PAYMENT OF

THE INSURED'S MEDICAL FEES

15b

CO-PAYMENT

16a

AMOUNT A PATIENT HAS TOPAY AT TIME OF SERVICE

DICTATED BY THE MANAGEDCARE CONTRACT (HMO, PPO,

OR POS)

16b

COINSURANCE

17a

A FIXED PERCENTAGE OFCOVERED CHARGES PAID BY

THE INSURED PERSON AFTER ADEDUCTABLE HAS BEEN MET

17b

CONTRACTED FEE SCHEDULE

18a

THIS IS WHEN PAYERS HAVE ANESTABLISHED FIXED FEE SCHEDULEWITH PARTICIPATING PHYSICIANSTHE TERMS FOR THE PLANDETERMINE WHAT PERCENTAGE OFTHE CHARGES IF ANY THE PATIENTOWES AND WHAT PERCENT THEPAYER COVERS.

18b

CONVERSION FACTOR - CF

19a

A NATIONALLY UNIFORMCONVERSION FACTOR IS A DOLLARAMOUNT USED TO MULTIPLY THERELATIVE VALUES TO PRODUCE APAYMENT AMOUNT. IT IS USED BYMEDICARE TO MAKE ADJUSTMENTSACCORDING TO CHANGES IN THECOST OF LIVING.

19b

CPT CODES

20a

COMMON PROCEDURALTERMINOLOGY CODES - A SET OFNUMBERS/LETTERS THATCORRESPOND TO COMMONPROCEDURE - THIS CODE IS ON THEENCOUNTER FORM AND ISTRANSPOSED TO THE INSURANCECLAIM FORM

20b

DEDUCTABLE

21a

A FIXED DOLLAR AMOUNTTHAT MUST BE PAID (YEARLY)

BY THE INSURED BEFOREEXPENSES ARE COVERED BY

THE INSURANCE

21b

DEFINE MEDI/MEDI

22a

WHAT OLDER OR DISABLED PATIENTS WHOHAVE MEDICARE AND WHO CAN NOT PAY THEDIFFERENCE BETWEEN THE BILL AND WHATMEDICARE PAYS MAY QUALIFY FOR MEDICAREMEDICAID. IN SUCH CASES MEDICARE IS THEPRIMARY PAYER.; MEDICAID PAYS THEREMAINDER OF THE BILL. THE PATIENT ISNEVER BILLED FOR A BALANCE UNLESS THESERVICE IS A NON-COVERED SERVICE.

22b

DISABILITY INSURANCE

23a

THE INSURANCE THATPROVIDES A MONTHLY,PREARRANGED PAYMENT TOAN INDIVIDUAL WHO CAN NOTWORK AS A RESULT OF ANINJURY ILLNESS OR DISABILITY

23b

ELECTIVE PROCEDURE

24a

A MEDICAL PROCEDURE THAT IS NOTREQUIRED TO SUSTAIN LIFE, BUT ISREQUESTED FOR PAYMENT TO THETHIRD PARTY PAYER BY THE PATIENTOR PHYSICIAN. SOME PROCEDURESARE PAID FOR BY THIRD PARTYPAYERS WHEREAS OTHERS ARE NOT -USUALLY NEED PREAUTHORIZATION

24b

ELECTRONIC DATAINTERCHANGE - EDI

25a

WHAT IS ELECTRONIC DATAINTERCHANGE - THETRANSMITTING OF ELECTRONICMEDICAL INSURANCE CLAIMSFROM PROVIDERS TO PAYERSUSING THE NECESSARYINFORMATION

25b

ENCOUNTER FORM OR SUPER-BILL

26a

A FORM THAT CAN BE USED AS THEORIGINAL MEDICAL RECORD OF SERVICESPERFORMED FOR A PATIENT DURING ANENCOUNTER OR OFFICE VISIT, ANDCHARGES FOR THOSE SERVICES. THE FORMCAN ALSO BE USED AS A CHARGE SLIP, ASWELL AS AN INVOICE. IT CAN ALSO BESUBMITTED WITH INSURANCE CLAIMS.

26b

EXCLUSION

27a

AN EXPENSE THAT IS NOTCOVERED BY A PARTICULAR

INSURANCE POLICY, SUCH ASEYE EXAMS OR DENTAL CARE

27b

EXPLANATION OF BENEFITS -EOB

28a

A FORM THAT EXPLAINS THE AMOUNTBILLED, AMOUNT ALLOWED BY INSURANCECONTRACT, AMOUNT PAID BY INSURANCECARRIER/COMPANY, AMOUNT OFSUSCRIBER'S/PATIENT'S LIABILITY, ANDNOTATIONS OF ANY NON COVEREDSERVICES WITH EXPLANATIONS.

28b

FEE FOR SERVICE

29a

FORMERLY INDEMNITY INSURANCE -A MAJOR TYPE OF HEALTHINSURANCE PLAN THAT REPAYSPOLICY HOLDERS FOR THE COSTS ORA PERCENTAGE OF THE HEALTHCARECOSTS REDULTING FROM AN ILLNESSOR INJURY

29b

FEE SCHEDULE

30a

A LIST OF COMMON SERVICESAND PROCEDURES

PERFORMED BY A PHYSICIANAND THE CHARGES OF EACH

30b

FICA

31a

FEDERAL INSURANCECONTRIBUTIONS ACT -MANAGED MEDICARE

31b

GEOGRAPHIC ADJUSTMENTFACTOR - GAF

32a

A GEOGRAPHIC ADJUSTMENTFACTOR IS USED TO ADJUSTEACH RELATIVE VALUE TOREFLECT A GEOGRAPHICALAREA'S RELATIVE COSTS SUCHAS OFFICE RENTS.

32b

HEALTH MAINTENANCEORGANIZATION (HMO)

33a

HEALTH CARE ORGANIZATION THAT ESTABLISHES ANETWORK OF PROVIDERS WHO PROVIDE SPECIFICSERVICES TO INDIVIDUALS AND THEIR DEPENDENTSWHO ARE ENROLLED IN THE PLAN. PHYSICIANS WHOENROLL WITH AN HMO AGREE TO PROVIDE CERTAINSERVICES IN EXCHANGE FOR A PREPAID FEE ORCAPITIATION PAYMENT. REFERRALS ARE NECESSARYTO SEE A SPECIALIST AND PREAUTHORIZATION ISREQUIRED FOR NON-EMERGENCY PROCEDURES

33b

ICD-9 OR ICD-10 CODES

34a

INTERNATIONAL CLASSIFICATION OFDISORDERS/DISEASES - A CODE ORSET OF NUMBERS/LETTERS THATCORRESPOND TO PATIENT DIAGNOSIS- THEY ARE ON THE ENCOUNTERFORM AND USED FOR INSURANCECLAIMS

34b

LIABILITY INSURANCE

35a

WHAT IS A TYPE OF INSURANCETHAT COVERS INJURIESCAUSED BY THE PROVIDER ORINJURIES THAT OCCURED ONTHE PROVIDER'S PROPERTY

35b

LIFETIME MAXIMUM BENEFIT

36a

THE TOTAL SUM THAT AHEALTH PLAN WILL PAY OUT

OVER THE PATIENT'S LIFE TIME

36b

MEDICAID

37a

WHAT IS A FEDERALLY FUNDEDHEALTH COST ASSISTANCE PROGRAMFOR THE LOW INCOME, BLIND, ANDDISABLED PATIENTS, FAMILIESRECIEVING AID TO DEPENDENTCHILDREN, FOSTER CHILDREN, ANDCHILDREN WITH BIRTH DEFECTS.

37b

MEDICARE

38a

NATIONAL HEALTH INSPROGRAM FOR AMERICANSOVER AGE 65 OR WHO ARE

DISABLED OR CHRONICKIDNEY PATIENTS RECEIVING

DIALYSIS38b

MEDICARE ADVANTAGE PLANS

39a

PPO'S, HMO'S, PRIVATE FEE FORSERVICE PLANS, AND MEDICAREMEDICAL SAVINGS ACCOUNTS THATPROVIDE MEDICARE BENEFICIARIESWITH PLAN COVERAGE CHOICES INADDITION TO THE TRADITIONALMEDICARE PLAN FOR A FEE

39b

MEDIGAP

40a

PRIVATE INSURANCE THATMEDICARE BENEFICIARIES CANPURCHASE TO REDUCE THE GAPS INMEDICARE COVERAGE OR THEAMOUNT THEY WOULD HAVE TO PAYFROM THEIR OWN POCKETS AFTERRECEIVING MEDICARE BENEFITS

40b

PART A AND PART B MEDICARE

41a

PART A = HOSPITAL BENEFIT FINANCEDTHROUGH FICA -PAYS FOR UP TO A 90 DAYHOSPITALIZATION OR UP TO 60 DAYSSKILLED NURSING FACILITYPART B = COVERS A PORTION FOROUTPATIENT PROCEDURES AND SUPPLIES.THIS PART IS VOLUNTARY. PREMIUM ISBASED ON INCOME AND INCREASESANNUALLY.

41b

PART D MEDICARE

42a

PART OF MEDICARE THATCOVERS PRESCRIPTIONS(OPTIONAL FOR A FEE)

42b

PARTCIPATING PROVIDERS

43a

PROVIDERS (DOCTORS,SURGEONS, ETC) WHO ENROLL INMANAGED CARE PLANS. THEYHAVE CONTRACTS WITHMANAGED CARE COMPANIESTHAT STIPULATE THIER FEES

43b

PCP

44a

PRIMARY CARE PROVIDER -THE PATIENT'S MEDICAL

DOCTOR

44b

POINT OF SERVICE - POS PLANS

45a

INSURANCE PLAN THATCOMBINES FEATURES OF HMOAND PPO - REFERRALS MAY BEGIVEN IN AND OUT OF NETWORKWHICH MAY REQUIRE AGREATER COPAYMENT BY THEPATIENT

45b

PRECERTIFICATION /PREAUTHORIZATION

46a

THE PROCESS OF THEPROVIDER CONTACTING THEINSURANCE PLAN TO SEE IFTHE PROPOSED PROCEDURE ISCOVERED UNDER THEPATIENTS INSURANCE PLAN

46b

PREFERRED PROVIDERORGANIZATION (PPO)

47a

A MANAGED CARE PLAN THATESTABLISHES A NETWORK OFPROVIDERS TO PERFORMSERVICES FOR PLAN MEMBERS;REFERRALS NOT NEEDED TOSEE A SPECIALIST

47b

PREMIUM

48a

THE BASIC ANNUAL COST OFHEALTH CARE INSURANCE

48b

RAC PROGRAM

49a

WHAT IS THE RECOVERY AUDITCONTRACTOR PROGRAM -

THEY FIND WASTE FRAUD ANDABUSE IN MEDICARE.

49b

REFERRAL

50a

AN AUTHORIZATION FROM AMEDICAL PRACTICE FOR APATIENT TO HAVE SPECIALIZEDSERVICES PERFORMED BYANOTHER PRACTICE (APPROVALIS OFTEN REQUIRED FORINSURANCE PURPOSES)

50b

REMITTANCE ADVICE - RA

51a

FORM USED BY MEDICARETHAT EXPLAINS THE BENEFITS(SIMILAR TO EOB FOR PRIVATE

INSURANCE)

51b

RESOURSE BASED RELATIVEVALUE SCALE - RBRVS

52a

THE PAYMENT SYSTEM USEDBY MEDICARE. IT ESTABLISHESTHE RELATIVE VALUE UNITSFOR SERVICES, REPLACING THEPROVIDER CONSENSUS ONUSUAL FEES

52b

RVU - RELATIVE VALUE UNIT

53a

THE NATIONALLY UNIFORMRELATIVE VALUE UNIT IS BASEDON THREE COST ELEMENTS. THEPHYSICIANS WORK, THEPRACTICE COST (OVERHEAD) ANDTHE COST OF MALPRACTICEINSURANCE.

53b

SCHIP

54a

THE STATE CHILDREN'S HEALTHINSURANCE PLAN. THIS PLAN ALLOWSSTATES TO PROVIDE HEALTHCOVERAGE TO UNINSURED CHILDRENAND FAMILIES WHOSE INCOMES ARETOO HIGH TO QUALIFY FOR MEDICAIDBUT ARE ALSO TOO LOW TO AFFORDPRIVATE INSURANCE.

54b

SNF

55a

SKILLED NURSING FACILITY

55b

TRICARE

56a

A GOVERNMENT PROGRAM THATPROVIDES HEALTH CARE BENEFITS FORDEPENDENTS OF MILITARY PERSONNELAND MILITARY RETIREES. THIS IS NOT ANINSURANCE PLAN BUT RATHER A HEALTHCARE BENEFIT FOR FAMILIES OFUNIFORMED PERSONNEL AND RETIREESFROM UNIFORMED SERVICES.

56b

UCR - USUAL, CUSTOMARY,AND RESONABLE

57a

INSURANCE COMPANIES BASE THEIR PAYMENTS ON AUSUAL, CUSTOMARY, AND REASONABLE FEE FOR APARTICULAR SERVICE. USUAL - PHYSICIAN'S USUAL FEEFOR A GIVEN SERVICE; THE FEE MOST FREQUENTLYCHARGED FOR THE SERVICE. CUSTOMARY -RANGE OFUSUAL FEES FOR A SERVICE CHARGED BY PHYSICIANSWITH SIMILAR TRAINING AND EXPERIENCE WHOPRACTICE IN THE SAME GEOGRAPHIC AREA.REASONABLE - FEE FOR EXCEPTIONALLY DIFFICULT ORCOMPLICATED SERVICE OR A PROCEDURE THATREQUIRES EXTRAORDINARY TIME OR EFFORT BY APHYSICIAN

57b

WHAT ARE THE TYPES OFREIMBURSEMENT THIRD

PARTY PAYERS USE.

58a

ALLOWED CHARGESCONTRACTED FEE SCHEDULE

CAPITATION

58b

WHAT IS TRICARE FORMERLYKNOWN AS

59a

CHAMPUS

59b

WHO RUNS THE TRICARE

60a

THE DEFENCE DEPARTMENT

60b

WORKERS COMPENSATIONINSURANCE

61a

THIS INSURANCE COVERSEMPLOYMENT RELATEDACCIDENTS OR DISEASES.FEDERAL LAW REQUIRESEMPLOYERS TO PURCHASE ANDMAINTAIN A CERTAIN MINIMUMAMOUNT OF WORKERS COMP INS.

61b