First 4 pages of CCMA

Advance beneficiary notice (ABN)

A form provided to the patient when the provider believes Medicare will probably not pay for services received. The ABN informs patients of their financial responsibility if Medicare denies coverage, allowing them to make informed decisions regarding their care.

Allowed amount

The maximum amount a third-party payer will pay for a particular procedure or service.

Copayment

An amount of money that is paid at the time of medical service

Coininsurance

A policy provision frequently found in medical insurance whereby the policyholder and the insurance company share the cost of covered losses in a specified ratio, such as 80:20

Deductible

A specific amount of money a patient must pay out of pocket before the insurance carrier begins paying.

Explanation of Benefits

A statement from the insurance carrier detailing what was paid, denied, or reduced in payment; also contains information about amounts applied to the deductible, coinsurance, and allowed amounts.

Participating provider (PAR)

Providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer.

Medicare

generally covers patients age 65 and older by Part A (hospitalization) or Part B (routine medical office visits) benefits.

Tricare

authorizes dependents of military personnel to receive treatment form civilian providers as the expense of the federal government.

CHAMPVA

covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities.

Medicaid

provides health insurance to the medically indigent population through a cost-sharing program between federal and state governments for those who meet specific eligibility criteria.

Managed care

is an umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care through a defined network or providers and hospitals.

Workers’ compensation

protects wage earners against the loss of wages and the cost of medical care resulting form an occupational accident or disease as long as the employee is not proven negligent.

How is the CMS-1500 Form divided?

section1 : carrier block —> contains the address of the insurance carrier and is located at the top of the form

section 2: Patient/insured section—> contains information about the patient of insured

Section 3: Physician/supplier Section —> contains information about the physician or supplier

Supine position

Dorsal recumbent position

sims’ posiiton

knee-elbow position

Fowler’s position

Lithotomy position

Apathy

indifference; a lack of interest, feeling concern, or emotion

compensation

a method of balancing a failure or inadequacy with an accomplishment.

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