Chapter 8 - 10 KeysTerms

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Abuse

Improper or harmful procedures or methods of doing business that are contradictory to accepted business practices

Balance Billing

Practice of billing patients for any balance left their deductible, coinsurance, insurance payments have been made.

Medically Needy

Individual who do not qualify in the categorically needy program, but need help to pay excessive medical expenses

Allowable Charges

Fees Medicare allows for a particular service or supply

Adjudicated

How a decision was made regarding the payment of an insurance claim.

End-stage renal disease (ESRD)

Permanent kidney disorders requiring dialysis or transplant

Claims Processor

Facility that handles TRICARE cliams for healthcare received within a particular state or region

Sponsor

Under the TRICARE plan a service member whether in active duty, retired, or deceased

XPressClaim

Secure, streamlined Web-based system that allows providers to submit TRICARE claims electronically and , in most cases to get fast results

Earned Income

Income from employment

Egregious

Conspicuously Negligent

Benefit Cap

Maximum benefit amount paid for any one incident or any one year