Medicaid
Centers for Medicare and Medicaid Services (U.S.)
A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.
State Health Plans
United States
The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.
Eligibility Determination
Managed Care Programs
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Insurance, Health, Reimbursement
State Government
Medically Uninsured
Individuals or groups with no or inadequate health insurance coverage. Those falling into this category usually comprise three primary groups: the medically indigent (MEDICAL INDIGENCY); those whose clinical condition makes them medically uninsurable; and the working uninsured.
Medicare
Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)
Insurance Coverage
Health Services Accessibility
Capitation Fee
Insurance, Health
Insurance Claim Review
Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
Health Expenditures
The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.
Cost Control
The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)
Reimbursement, Disproportionate Share
Payments that include adjustments to reflect the costs of uncompensated care and higher costs for inpatient care for certain populations receiving mandated services. MEDICARE and MEDICAID include provisions for this type of reimbursement.
Patient Protection and Affordable Care Act
An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.
Health Services Research
The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)
Uncompensated Care
Medical services for which no payment is received. Uncompensated care includes charity care and bad debts.
Cost Savings
Poverty
Formularies as Topic
Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPOEIAS in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.
Health Maintenance Organizations
Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)
Federal Government
Health Care Reform
Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.
Oregon
I'm sorry for any confusion, but the term "Oregon" is a geographical location and not a medical concept or condition. It is a state in the Pacific Northwest region of the United States. If you have any questions related to medical topics, I would be happy to help answer those!
Tennessee
I'm sorry for any confusion, but the term "Tennessee" is not a medical concept or condition that has a defined meaning within the medical field. It is a geographical location, referring to a state in the United States. If you have any questions related to healthcare, medicine, or health conditions, I would be happy to help answer those!
Florida
I'm sorry for any confusion, but "Florida" is a geographical location and not a medical term or condition with a specific definition. It is the 27th largest state by area in the United States, located in the southeastern region of the country and known for its diverse wildlife, beautiful beaches, and theme parks. If you have any medical questions or terms that need clarification, please feel free to ask!
Maryland
I'm sorry for any confusion, but the term "Maryland" is not a recognized medical term with a specific definition in the medical field. It refers to a state in the United States. If you have any questions about a medical condition or treatment, I would be happy to try and help answer those!
Nursing Homes
Health Care Surveys
Budgets
Health Policy
Arkansas
I'm sorry for any confusion, but the term "Arkansas" is a place name and does not have a medical definition. It is a state located in the southern region of the United States.
Health Care Costs
The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.
Insurance, Pharmaceutical Services
New Jersey
(I'm assuming you are asking for a play on words related to the state of New Jersey, as "New Jersey" is not a medical term.)
Drug Costs
The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).
North Carolina
(Note: 'North Carolina' is a place, not a medical term. However, I can provide a fun fact related to health and North Carolina.)
Dental Care for Children
Insurance Benefits
Michigan
I'm sorry for any confusion, but the term "Michigan" is not a medical concept or condition that has a defined meaning within the medical field. It refers to a state in the United States, and does not have a direct medical connotation.
California
I'm sorry for any confusion, but "California" is a place, specifically a state on the western coast of the United States, and not a medical term or concept. Therefore, it doesn't have a medical definition.
Inflation, Economic
Medicare Assignment
Concept referring to the standardized fees for services rendered by health care providers, e.g., laboratories and physicians, and reimbursement for those services under Medicare Part B. It includes acceptance by the physician.
Reimbursement, Incentive
A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.
Maine
##### Not a valid request: I'm sorry for any confusion, but "Maine" is a state in the northeastern United States and not a medical term or condition with a specific definition in the healthcare context.
Risk Sharing, Financial
Any system which allows payors to share some of the financial risk associated with a particular patient population with providers. Providers agree to adhere to fixed fee schedules in exchange for an increase in their payor base and a chance to benefit from cost containment measures. Common risk-sharing methods are prospective payment schedules (PROSPECTIVE PAYMENT SYSTEM), capitation (CAPITATION FEES), diagnosis-related fees (DIAGNOSIS-RELATED GROUPS), and pre-negotiated fees.
Fraud
Social Welfare
Medical Assistance
Financing of medical care provided to public assistance recipients.
Drug Utilization Review
Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993.
Fee Schedules
Cost Sharing
Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)
Long-Term Care
Ohio
Insurance, Physician Services
Legislation, Hospital
Public Assistance
Quality of Health Care
Data Collection
Kentucky
I'm sorry for any confusion, but "Kentucky" is a proper noun and not a term that has a medical definition. It is a state located in the eastern region of the United States. If you have any questions related to medical conditions or terminology, I would be happy to help answer those!
Utilization Review
Cost Allocation
Drug Utilization
Health Services Needs and Demand
South Carolina
I'm sorry for any confusion, but "South Carolina" is a geographical location and not a medical term or concept, so it doesn't have a medical definition. It is a state located in the Southeastern region of the United States.
Diagnosis-Related Groups
A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.
Case Management
A traditional term for all the activities which a physician or other health care professional normally performs to insure the coordination of the medical services required by a patient. It also, when used in connection with managed care, covers all the activities of evaluating the patient, planning treatment, referral, and follow-up so that care is continuous and comprehensive and payment for the care is obtained. (From Slee & Slee, Health Care Terms, 2nd ed)
Prenatal Care
Disabled Persons
Costs and Cost Analysis
Retrospective Studies
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
Health Care Sector
Ownership
Models, Econometric
Massachusetts
I'm sorry for any confusion, but "Massachusetts" is a geographical location and not a medical term or concept. It is a state located in the northeastern region of the United States. If you have any medical questions or terms you would like me to define, please let me know!
Legislation, Medical
Missouri
whoa, I'm just an AI and I don't have the ability to provide on-the-fly medical definitions. However, I can tell you that "Missouri" is not a term commonly used in medicine. It's a state in the United States, and I assume you might be looking for a medical term that is associated with it. If you could provide more context or clarify what you're looking for, I'd be happy to help further!
United States Dept. of Health and Human Services
A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.
Skilled Nursing Facilities
Home Care Services
Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.