Various student generated terms from Medicare Glossary

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Across
  1. 4. The beneficiary's share of the costs of a covered health care service, calculated as a percent of t he allowed amount for the service.
  2. 6. Maximum amount on which payment is based for covered health care services; may also be called 'eligible expense'
  3. 9. A provider who has a contract with a health insurer or plan to provide services at a discount
  4. 10. Health care services that help a person keep, learn or improve skills and functioning for daily living.
  5. 13. Something health insurances or plans may require before a certain service may be provided
  6. 14. When a provider bills for the difference between the provider's charge and the allowed amount.
  7. 16. Negative changes that occur to an O/P device due to a specific accident or to a natural disaster.
  8. 19. Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition disease or its symptoms and that meed accepted standards of medicine.
  9. 20. A submission for payment by a provider to Medicare for services rendered that does not require investigation or development outside the DME MAC operation on a prepayment basis.
Down
  1. 1. The amount the beneficiary must pay for health care or prescriptions before Medicare or other insurance begins to pay.
  2. 2. Per Medicare, this 'consist of heart disease, hypertension, diabetes, arthritis, osteoporosis, broken hip, pulmonary disease, stroke,Parkinson's disease and urinary incontinence that occurs once a week or more often.
  3. 3. (Abbv) A method of payment where payment is made for services as they are rendered; contrasted with prepayment or capitation
  4. 5. A provider who doesn't have a contract with a health insurer or plan to provide services to the insured individuals.
  5. 7. An agreement by a healthcare provider to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill for any more than the Medicare deductible and coinsurance.
  6. 8. (Abbv) The amount paid for a medical service in a geographical area based on what providers in the area usually charge for the same or similar medical service.
  7. 10. (Abbv) A type of insurance that provides, or arranges fr the provision of, a comprehensive package of health care services to enrolled persons, for a fixed capitation payment.
  8. 11. A method of payment whereby in exchange for a fixed payment, an entity such as an HMO agrees to provide ea comprehensive package of health care services to an individual on a "as-needed" basis;
  9. 12. A health care program that assists low-income families or individuals unable to afford regular medical service that is financed by the state and federal governments
  10. 15. The amount that must be paid for a health insurance or plan; typically paid monthly, quarterly or yearly.
  11. 17. (Abbv) The expected minimum lifespan for an O/P device and is used to determine how often it is feasible to pay for the replacement under the Medicare program.
  12. 18. Items that are identical or comparable to items previously paid for by Medicare and if provided within the Reasonable Useful Lifetime it maybe denied