In the Medicare program, the dollar amount of a medical service that has been denied and then appealed by the provider and patient to the insurance carrier for redetermination.
Insurance Encyclopedia
Amount, duration, and scope
Medicaid parameters defining a state’s benefits. Because each state has different Medicaid plans, these benefits will vary from state to state.
Amounts made good
The sums contributed as general average contributions to make good general average sacrifices. The allowances or amounts to be made good are formula-based to ensure equity in the adjustment. With expenditure, the amount made good is the expenditure itself.
Amounts paid in error
Payment of a claim in error by an insurer is recoverable if the mistake is of a fact, but not if the payment is by mistake of law. Failure to deduct excesses or apply average are mistakes of fact and can be recovered.
Analysis
Analytic system for the measurement of relative Fire hazard. A system for measuring the relative probability of Fire loss to property and of determining Fire Insurance premium rates.
Analysis of Risk
Process of locating loss exposures, measuring the amount of loss that exposures can produce, estimating the loss probability, and evaluating the exposures to determine actions necessary to meet the business (or family) risk management objective.
Anatomic modifiers
In Healthcare Common Procedure Coding System (HCPCS) Level II coding, two alphanumeric characters placed after the usual five-digit CPT procedure code number. These modifiers are used to identify specific anatomical parts of the body when the CPT procedure code does not include that information. HCPCS modifiers are accepted by insurance carriers nationally and are updated annually by the Centers for Medicare and Medicaid Services (CMS).
Anatomy
The study of the structures of the human body and the relationship between them.
Anchor group
Large medical group composed of multispecialists with multidisciplines that under managed care contracts handle the bulk of treatments and referrals of member patients and carry most of the clinical risk. Also called key groups or core groups.
Ancillary
Supplemental health care service required as part of giving other care such as anesthesia, laboratory, pharmacy, and radiology; other than routine hospital services (room, board, medical and nursing services).
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Fees charged for additional services (other than room and board charges), such as x-rays, anesthesia, lab work, etc. The term may also be used to describe the charge made by a pharmacy for prescriptions which exceed the health insurance policy’s maximum allowable cost.