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

Prospective payment system

Insurance; Medicare & Medicaid

A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that ...

Consumer survey data

Insurance; Medicare & Medicaid

Data collected through a survey of those Medicaid beneficiaries who are enrolled in the programme and have used the services. The survey may be conducted by the State or by the managed care entity ...

Letter of request

Insurance; Medicare & Medicaid

A formal request from the requestor on organisational letterhead detailing their data needs and purposes. Additionally, if this project is federally funded a letter of Support is required from the ...

Ombudsman

Insurance; Medicare & Medicaid

An ombudsman is an individual who assists enrollees in resolving problems they may have with their MCO/PHP. An ombudsman is a neutral party who works with the enrollee, the MCO/PHP, and the provider ...

Military service wage credits

Insurance; Medicare & Medicaid

Credits recognising that military personnel receive other cash payments and wages in kind (such as food and shelter) in addition to their basic pay. Noncontributory wage credits of $160 are provided ...

Open enrollment period

Insurance; Medicare & Medicaid

A one-time-only six month period when you can buy any Medigap policy you want that is sold in your State. It starts in the first month that you are covered under Medicare Part B and you are age 65 or ...

Performance improvement projects

Insurance; Medicare & Medicaid

Projects that examine and seek to achieve improvement in major areas of clinical and non-clinical services. These projects are usually based on information such as enrollee characteristics, ...