5 Terms
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Medicare & Medicaid
Medical insurance programs administered by the U.S. federal government that provide health care coverage for the elderly (people over 65) and certain people and families with low incomes and resources.
Industry: Insurance
Add a new termContributors in Medicare & Medicaid
Medicare & Medicaid
Quality
Insurance; Medicare & Medicaid
Quality is how well the health plan keeps its members healthy or treats them when they are sick. Good quality health care means doing the right thing at the right time, in the right way, for the ...
Incidence
Insurance; Medicare & Medicaid
The frequency of new occurrences of a condition within a defined time interval. The incidence rate is the number of new cases of specific disease divided by the number of people in a population over ...
Fraud
Insurance; Medicare & Medicaid
The intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some ...
Managed care organisation
Insurance; Medicare & Medicaid
Managed Care organisations are entities that serve Medicare or Medicaid beneficiaries on a risk basis through a network of employed or affiliated providers. Stands for Managed Care Organization. The ...
Test of short-range financial adequacy
Insurance; Medicare & Medicaid
The conditions required to meet this test are as follows: (1) If the trust fund ratio for a fund exceeds 100 percent at the beginning of the projection period, then it must be projected to remain at ...
Potential payments
Insurance; Medicare & Medicaid
Means the maximum anticipated total payments (based on the most recent year's utilisation and experience and any current or anticipated factors that may affect payment amounts) that could be received ...
National improvement projects
Insurance; Medicare & Medicaid
HCQIP projects developed by a group consisting of representatives of some or all of the following groups: CMS, Public Health Service, Networks, renal provider, and consumer communities. The object is ...
