The billing form, or invoice, that is a request for Medicare payment.

The process of billing separately for services that could have been grouped together.

Services by providers for which no payment is received from the patient or from third-party payers.

Individuals with public or private insurance policies that do not cover all necessary medical services, resulting in out-of-pocket expenses that exceed their ability to pay.

The process of reviewing an individual’s health status to determine eligibility for coverage under an insurance plan.

A reverse mortgage that becomes due and payable on a specific date

The improper practice of reporting assessment or treatment information that is inaccurate or unsupported in order to obtain higher reimbursement levels.

One method used by private insurers to calculate what to pay for medical services. It bases pay rates on commonly used rates in the local community. Also called “customary, prevailing and reasonable” charges.

The group at a skilled nursing facility responsible for determining how resources are being utilized, typically for Medicare Part A. This committee addresses questions such as whether a person should continuing receiving Medicare coverage and whether he or she requires a skilled level of care.