Used when billing medical services rendered at a residential care facility that houses Medicare beneficiaries who cannot live alone but who do not need around-the-clock skilled medical services. The facility services do not include a professional medical component.

Insurance policy that shows the name of the patient (insured or subscriber) as the policyholder.

Insurance policy that shows the name of the patient as a dependent on a second insurance policy.

Agreement given to the patient to read and sign before rendering a service if the participating physician thinks that it may be denied for payment because of medical necessity or limitation of liability by Medicare. The patient agrees to pay for the service. ABNs only apply if the patient is in the original Medicare program. They do not apply if the patient is in a Medicare managed care plan or private fee-for-service plan. May be referred to as an ABN-G (i.e., ABNs used by providers, physicians, practitioners, and suppliers). An ABN is also known as a waiver of liability agreement, responsibility statement , or notice of noncoverage. ABN-L refers to ABNs used when only laboratory services are being delivered. HHABN is an ABN used for home health services.

Check sent to the provider before filing of an insurance claim for medical services or billing statement for an insurance examination.

Determination that the patient’s private fee-for-service plan makes on whether or not it will pay for a particular medical service.

As specified in the Patient Self-Determination Act, this is a legal document prepared by an individual that gives directions about his or her wishes in the event he or she becomes incapacitated and not able to make decisions. It designates a person to make medical decisions. An advance directive includes such documents as do-not-resuscitate (DNR) order, durable power of attorney, right to die document, and living will. Also called health care advance directive or living will.

Certification of those professionals who take care of seriously injured or ill patients.

Certification offered by the Board of Advanced Medical Coding (BAMC) to physician and facility coders who successfully complete the qualifying examination. See Board of Advanced Medical Coding (BAMC).