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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
Advisory Council on Social Security
Insurance; Medicare & Medicaid
Prior to the enactment of the Social Security Independence and programme Improvements Act of 1994 (Public Law 103-296) on August 15, 1994, the Social Security Act required the appointment of an ...
Reasonable-cost basis
Insurance; Medicare & Medicaid
The calculation to determine the reasonable cost incurred by individual providers when furnishing covered services to beneficiaries. The reasonable cost is based on the actual cost of providing such ...
Personal care
Insurance; Medicare & Medicaid
Nonskilled, personal care, such as help with activities of daily living like bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom. It may also include ...
Abuse
Insurance; Medicare & Medicaid
A range of the following improper behaviours or billing practises including, but not limited to: * Billing for a non-covered service; * Misusing codes on the claim (i.e., the way the service is coded ...
Designated standard maintenance organisation
Insurance; Medicare & Medicaid
An organization, designated by the Secretary of the U.S. Department of Health & Human Services, to maintain standards adopted under Subpart I of 45 CFR Part 162. A DSMO may receive and process ...
Cost-based health maintenance organisation
Insurance; Medicare & Medicaid
A type of managed care organisation that will pay for all of the enrollees/members' medical care costs in return for a monthly premium, plus any applicable deductible or co-payment. The HMO will pay ...
National Uniform Billing Committee
Insurance; Medicare & Medicaid
An organization, chaired and hosted by the American Hospital Association, that maintains the UB-92 hardcopy institutional billing form and the data element specifications for both the hardcopy form ...
