Physician

GLOSSARY
A
Advance Beneficiary Notice
A written notice that a provider or supplier gives to a beneficiary under certain
circumstances (e.g., lack of medical necessity) before items or services are furnished to
advise him or her that specified items or services may not be covered by Medicare.
Appeal
Complaint a beneficiary, provider of services, or supplier can make if he or she
disagrees with a Medicare coverage or payment decision.
Assignment
When a provider or supplier is paid the Medicare allowed amount as payment in full for
his or her services.
B
Beneficiary
Individual eligible to receive Medicare or Medicaid payment and/or services.
C
Carrier
Centers for Medicare & Medicaid Services Contactor that determines reasonable
charges, accuracy, and coverage for Medicare Part B services and processes Part B
claims and payments (see Medicare Administrative Contractor).
Centers for Medicare & Medicaid Services
The Federal agency that administers and oversees the Medicare Program and a portion
of the Medicaid Program. It also regulates laboratory testing and surveys and certifies
Rural Health Clinics, Federally Qualified Health Centers, Critical Access Hospitals,
nursing homes, health care agencies, intermediate care facilities for the mentally
retarded, and hospitals.
Claim
A request for payment of benefits or services received by a beneficiary.
Code of Federal Regulations
Official compilation of Federal rules and requirements.
Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 79