MBIC

Appoved Charges

A fee that Medicare decides the medical services is worth,which may or may not be the same as the actual amount billed.The patient may or may not be responsible for the difference.
Assignment
A transfer,after an event insured against, or an individual’s legal right to collect an amount payable under an insurance contract.For Medicare,an agreement in which a aptient assigns to tyhe physician the right to receive payment from the Medicare administrative contractor.Under this agreement, the physician must agree to accept 80% of the allowed amount as payment in full once the deductible has been met.For TRICARE, providers who accept assignment agree to accept 75% or 80% of the TRICARE allowable charge as the full fee,collecting the deductible and 20% or 25% of the allowable charge from the patient.With other carriers,accepting assignment means that,in return for payment of the claim,the provider accepts the terms of the contract between the patient and carrier.The provider also accepts the payment from the carrier as payment in full with no balance billing of the patient.
Benefit Period
A period of time for which payments for Medicare inpatient hospital benefits are available.A benefit period begins the first day an enrollee is given inpatient hospital care (nursing care or rehabiliation services) by an qualified provider and ends when the enrollee has not been an inpatient for 60 consecurative days.In worker’s compensation cases,it is the maximum amount of time that benefits will be paid to the injured or ill person for the disability.For disability inusurance,it is the maximum amount of time thta benefits willl be paid to th injured or ill person for a disability.
Crossover Claim
A bill for services rendered to a patient receiving benefits simultaneously from Medicare and Medicaid or from Medicare and a Medigap plan. Medicare pays first and then determines the amounts of unmet Medicare deductible and coinsurance to be paid by the secondary insurance carrier.The claim is automatically transferred (Eloctronically)to the secondary insurance carrier for additional payment.Also known as Claim Transfer.
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