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
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Medicare & Medicaid
Data support access facility access form
Insurance; Medicare & Medicaid
A form that is required for access to Leg 1 (Enrollment Database (EDB)) and, Leg 2 (Medicare Provider Analysis and Review(MEDPAR)) of the Data Support Access Facility.
Federal Insurance Contributions Act
Insurance; Medicare & Medicaid
Provision authorising taxes on the wages of employed persons to provide for the OASDI and HI programs. Covered workers and their employers pay the tax in equal amounts.
Pattern analysis
Insurance; Medicare & Medicaid
The clinical and statistical analysis of data sets. Frequently used ESRD data sets include the PMMIS, USRDS, the core indicators, Network files, or CMS analytic files.
Internal controls
Insurance; Medicare & Medicaid
Management systems and policies for reasonably documenting, monitoring, and correcting operational processes to prevent and detect waste and to ensure proper payment.
Data mapping
Insurance; Medicare & Medicaid
The process of matching one set of data elements or individual code values to their closest equivalents in another set of them. This is sometimes called a cross-walk.
On-site reviews
Insurance; Medicare & Medicaid
Reviews performed on-site at the MCO/PHP health care delivery system sites to assess the physical resources and operational practises in place to deliver health care.
Actuarial status
Insurance; Medicare & Medicaid
A measure of the adequacy of the financing as determined by the difference between assets and liabilities at the end of the periods for which financing was established.
