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

False negatives

Insurance; Medicare & Medicaid

Occur when the medical record contains evidence of a service that does not exist in the encounter data. This is the most common problem in partially or fully capitated plans because the provider does ...

X12 standard

Insurance; Medicare & Medicaid

The term currently used for any X12 standard that has been approved since the most recent release of X12 American National Standards. Since a full set of X12 American National Standards is only ...

Emergency Medical Treatment and Active labour Act (EMTALA)

Insurance; Medicare & Medicaid

The Emergency Medical Treatment and Active labour Act, codified at 42 U.S.C. § 1395dd. EMTALA requires any Medicare-participating hospital that operates a hospital emergency department to provide an ...

Home and community-based service waiver programmes (HCBS)

Insurance; Medicare & Medicaid

The HCBS programmes offer different choices to some people with Medicaid. If you qualify, you will get care in your home and community so you can stay independent and close to your family and ...

Cost rate

Insurance; Medicare & Medicaid

The ratio of the cost (or outgo, expenditures, or disbursements) of the programme on an incurred basis during a given year to the taxable payroll for the year. In this context, the outgo is defined ...

Regenstrief institute

Insurance; Medicare & Medicaid

A research foundation for improving health care by optimising the capture, analysis, content, and delivery of health care information. Regenstrief maintains the LOINC coding system that is being ...

Special election period

Insurance; Medicare & Medicaid

A set time that a beneficiary can change health plans or return to the Original Medicare Plan, such as: you move outside the service area, your Medicare+Choice organisation violates its contract with ...