Ambulance billing term - Assignment, capped rental item, Medical necessity

Assignment—An agreement between a person with Medicare, a doctor or supplier, and Medicare. Doctors or suppliers who accept assignment from Medicare agree to accept the Medicare-approved amount as full payment.


Capped rental item—Durable medical equipment (like oxygen, nebulizers, and manual wheelchairs) that costs more than $150,and is rented to people with Medicare more than 25% of the time.


Certificate of Medical Necessity—A form required by Medicare that your physician must complete to get Medicare coverage for certain medical equipment.

Coinsurance—An amount you may be required to pay for services after you pay any plan deductibles. In Original Medicare, this is a percentage (like 20%) of the Medicare-approved amount. You have to pay this amount after you pay the Part A and/or Part B deductible.

Deductible—The amount you must pay for health care or prescriptions, before Original Medicare or other insurance begins topay. For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.


Durable Medical Equipment—Medical equipment that is ordered by a doctor (or, if Medicare allows, a nurse practitioner, physician assistant, or clinical nurse specialist) for use in the home. A hospital or nursing home that mostly provides skilled care can’t qualify as a“home” in this situation. These medical items must be reusable,such as walkers, wheelchairs, or hospital beds.


Medically Necessary—Services or supplies that are needed for the diagnosis or treatment of your medical condition.

Medicare Advantage Plan (Part C)—A type of Medicare plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. Also called Part C, Medicare Advantage Plans are HMOs, PPOs, Private Fee-for-Service Plans, or Medicare Medical Savings Account Plans.If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, and are not paid for under Original Medicare.