Term
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Definition
| A fee that Medicare decides the medical service Is worth, which may or may not be the same as the actual amount billed. The patient may or may not be responsible for the difference. |
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Term
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Definition
| A transfer, after an event insured against, or an individual’s legal right to collect an amount payable under an insurance contract. |
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Term
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Definition
| A period of time for which payments for Medicare inpatient hospital benefits are available. A benefit period starts the first day an enrollee is given inpatient hospital care by a qualified provider and ends when the enrollee has not been an inpatient for 60 consecutive days. |
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Term
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Definition
| 1. A bill for services rendered to a patient receiving benefits simultaneously from Medicare and Medicaid or from Medicare and Medigap plan. |
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Term
| Diagnostic Cost groups ( DCGs)- |
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Definition
| 1. A system of Medicare reimbursement for HMOs with risk contracts in which enrollees are classified into various DCGs on the basis of each beneficiary’s prior 12-month hospitalization history. |
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Term
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Definition
| 1. For purposes of enrollment under Medicare, individuals younger than 65 years of age who have been entitled to disability benefits under the Social Security Act or the Railroad Retirement system for at least 24 months are considered disabled and are entitled to Medicare. |
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Term
| End stage Renal Disease (ESRD) |
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Definition
| 1. - Individuals who have chronic kidney disease requiring dialysis or kidney transplant are considered to have ESRD. |
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Term
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Definition
| 1. An organization under contract to the government that handles claims under Medicare Part A from hospitals, skilled nursing facilities, home health agencies, or providers of medical services and supplies. |
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Term
| Centers for Medicare and Medicaid Services (CMS) |
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Definition
| 1. - Formerly known as the Health Care Financing Administration (HCFA), CMS divides responsibilities among three divisions. |
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Term
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Definition
| 1. A public agency or private organization primarily engaged in providing pain relief, symptom management, and supportive service to terminally ill patients and their families in their own homes or in a home like center. |
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Term
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Definition
| 1. Known as Medicare Part A. A program providing basic protection against the costs of hospital and related after-hospital services for individuals eligible under the Medicare program. |
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Term
| Intermediate Care Facilities (ICFs) - |
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Definition
| 1. Institutions furnishing health-related care and services to individuals who do not require the degree of care provided by acute care hospitals or nursing facilities. |
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Term
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Definition
| A percentage limit on fees specified by legislation that nonparticipating physicians may bill Medicare beneficiaries above the fee schedule amount. |
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Term
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Definition
| The performance of services and procedures that are consistent with the diagnosis in accordance with standards of good medical practice, performed at the proper level, and provided in the most appropriate setting. Medical necessity must be established before the carrier may make payment. |
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