Medicare & Medicaid

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

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Medicare & Medicaid

Regional office

Insurance; Medicare & Medicaid

CMS has 10 Ros that work closely together with Medicare contractors in their assigned geographical areas on a day-to-day basis. Four of these Ros monitor Network contractor performance, negotiate ...

Urgently needed care

Insurance; Medicare & Medicaid

Care that you get for a sudden illness or injury that needs medical care right away, but is not life threatening. Your primary care doctor generally provides urgently needed care if you are in a ...

Reasonable cost

Insurance; Medicare & Medicaid

FIs and carriers use CMS guidelines to determine reasonable costs incurred by individual providers in furnishing covered services to enrollees. Reasonable cost is based on the actual cost of ...

Contingency

Insurance; Medicare & Medicaid

Funds included in the trust fund to serve as a cushion in case actual expenditures are higher than those projected at the time financing was established. Since the financing is set prospectively, ...

Enrollment

Insurance; Medicare & Medicaid

Is the process by which a Medicaid eligible person becomes a member of a managed care plan. Enrollment data refer to the managed care plan's information on Medicaid eligible individuals who are plan ...

Referral services

Insurance; Medicare & Medicaid

Means any specialty, inpatient, outpatient or laboratory services that are ordered or arranged, but not furnished directly. Certain situations may exist that should be considered referral services ...

Comprehensive mco

Insurance; Medicare & Medicaid

A MCO is a health maintenance organization, an eligible organisation with a contract under §1876 or a Medicare-Choice organization; a provider sponsored organisation or any other private or public ...