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)
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.
The voluntary portion of Medicare, known as the Supplementary Medical Insurance (SMI) Program, that includes physician's services, home health care, medical services, outpatient hospital services, and laboratory, pathology, and radiology services. All persons entitled to Medicare Part A may enroll in Medicare Part B on a monthly premium basis.
The compulsory portion of Medicare that is known as the Hospital Insurance Program. All persons 65 years and older who are entitled to benefits under the Old Age, Survivors, Disability and Health Insurance Program or railroad retirement, persons under the age of 65 who have been eligible for disability for more than two years, and insured workers (and their dependents) requiring renal dialysis or kidney transplantation are automatically enrolled in Medicare Part A.
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.
Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)
Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.
Processes or methods of reimbursement for services rendered or equipment.
Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.
A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.
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.
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.
The Commission was created by the Balanced Budget Act of 1997 under Title XVIII. It is specifically charged to review the effect of Medicare+Choice under Medicare Part C and to review payment policies under Parts A and B. It is also generally charged to evaluate the effect of prospective payment policies and their impact on health care delivery in the US. The former Prospective Payment Assessment Commission (ProPAC) and the Physician Payment Review Commission (PPRC) were merged to form MEDPAC.
A supplemental health insurance policy sold by private insurance companies and designed to pay for health care costs and services that are not paid for either by Medicare alone or by a combination of Medicare and existing private health insurance benefits. (From Facts on File Dictionary of Health Care Management, 1988)
Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)
Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.
A listing of established professional service charges, for specified dental and medical procedures.
A method of examining and setting levels of payments.
Criteria to determine eligibility of patients for medical care programs and services.
Economic aspects related to the management and operation of a hospital.
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)
Extended care facilities which provide skilled nursing care or rehabilitation services for inpatients on a daily basis.
Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.
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.
Pricing statements presented by more than one party for the purpose of securing a contract.
Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.
The design, completion, and filing of forms with the insurer.
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.
Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.
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.
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.
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.
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.
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)
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.
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.
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.
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)
The effort of two or more parties to secure the business of a third party by offering, usually under fair or equitable rules of business practice, the most favorable terms.
Coded listings of physician or other professional services using units that indicate the relative value of the various services they perform. They take into account time, skill, and overhead cost required for each service, but generally do not consider the relative cost-effectiveness. Appropriate conversion factors can be used to translate the abstract units of the relative value scales into dollar fees for each service based on work expended, practice costs, and training costs.
The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional.
The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)
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).
Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.
Facilities designed to serve patients who require surgical treatment exceeding the capabilities of usual physician's office yet not of such proportion as to require hospitalization.
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
Specialized health care, supportive in nature, provided to a dying person. A holistic approach is often taken, providing patients and their families with legal, financial, emotional, or spiritual counseling in addition to meeting patients' immediate physical needs. Care may be provided in the home, in the hospital, in specialized facilities (HOSPICES), or in specially designated areas of long-term care facilities. The concept also includes bereavement care for the family. (From Dictionary of Health Services Management, 2d ed)
Amounts charged to the patient as payer for medical services.
Outside services provided to an institution under a formal financial agreement.
Application of marketing principles and techniques to maximize the use of health care resources.
Institutions with an organized medical staff which provide medical care to patients.
Descriptive terms and identifying codes for reporting medical services and procedures performed by PHYSICIANS. It is produced by the AMERICAN MEDICAL ASSOCIATION and used in insurance claim reporting for MEDICARE; MEDICAID; and private health insurance programs (From CPT 2002).
A cancer registry mandated under the National Cancer Act of 1971 to operate and maintain a population-based cancer reporting system, reporting periodically estimates of cancer incidence and mortality in the United States. The Surveillance, Epidemiology, and End Results (SEER) Program is a continuing project of the National Cancer Institute of the National Institutes of Health. Among its goals, in addition to assembling and reporting cancer statistics, are the monitoring of annual cancer incident trends and the promoting of studies designed to identify factors amenable to cancer control interventions. (From National Cancer Institute, NIH Publication No. 91-3074, October 1990)
Amounts charged to the patient as payer for health care services.
Referral by physicians to testing or treatment facilities in which they have financial interest. The practice is regulated by the Ethics in Patient Referrals Act of 1989.
The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.
The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.
Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.
Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.
The confinement of a patient in a hospital.
Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.
Directions written for the obtaining and use of DRUGS.
The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine HOSPITAL CHARGES (the price the hospital sets for its services).
Laws concerned with manufacturing, dispensing, and marketing of drugs.
Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.
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.
The obtaining and management of funds for hospital needs and responsibility for fiscal affairs.
Subsequent admissions of a patient to a hospital or other health care institution for treatment.
Statistical models of the production, distribution, and consumption of goods and services, as well as of financial considerations. For the application of statistics to the testing and quantifying of economic theories MODELS, ECONOMETRIC is available.
An increase in the volume of money and credit relative to available goods resulting in a substantial and continuing rise in the general price level.
Drugs that cannot be sold legally without a prescription.
Process of shifting publicly controlled services and/or facilities to the private sector.
Economic sector concerned with the provision, distribution, and consumption of health care services and related products.
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.
Medical and skilled nursing services provided to patients who are not in an acute phase of an illness but who require a level of care higher than that provided in a long-term care setting. (JCAHO, Lexikon, 1994)
Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
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.
Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.
Organizations of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it. Assigned means those beneficiaries for whom the professionals in the organization provide the bulk of primary care services. (www.cms.gov/OfficeofLegislation/Downloads/Accountable CareOrganization.pdf accessed 03/16/2011)
Cost-sharing mechanisms that provide for payment by the insured of some portion of covered expenses. Deductibles are the amounts paid by the insured under a health insurance contract before benefits become payable; coinsurance is the provision under which the insured pays part of the medical bill, usually according to a fixed percentage, when benefits become payable.
A cabinet department in the Executive Branch of the United States Government concerned with overall planning, promoting, and administering programs pertaining to VETERANS. It was established March 15, 1989 as a Cabinet-level position.
The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.
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.
Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.
Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.
Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.
A nursing specialty involved in the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems with the characteristics of altered functional ability and altered life-style.
Hospitals located in a rural area.
Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).
Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.
An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided.
In health care reimbursement, especially in the prospective payment system, those patients who require an unusually long hospital stay or whose stay generates unusually high costs.
An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.
Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.
Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.
Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.
Activities concerned with governmental policies, functions, etc.
Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.
Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.
Advanced technology that is costly, requires highly skilled personnel, and is unique in its particular application. Includes innovative, specialized medical/surgical procedures as well as advanced diagnostic and therapeutic equipment.
Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment.
The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.
Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.
A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)
Services for the diagnosis and treatment of disease and the maintenance of health.
Public or private organizations that provide, either directly or through arrangements with other organizations, home health services in the patient's home. (Hospital Administration Terminology, 2d ed)
Government sponsored social insurance programs.
Drugs whose drug name is not protected by a trademark. They may be manufactured by several companies.
Differences in access to or availability of medical facilities and services.
Procedures used by chiropractors to treat neuromusculoskeletal complaints.
Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.
Short-term debt obligations and assets occurring in the regular course of operational transactions.
Assistance in managing and monitoring drug therapy for patients receiving treatment for cancer or chronic conditions such as asthma and diabetes, consulting with patients and their families on the proper use of medication; conducting wellness and disease prevention programs to improve public health; overseeing medication use in a variety of settings.
Organizations representing designated geographic areas which have contracts under the PRO program to review the medical necessity, appropriateness, quality, and cost-effectiveness of care received by Medicare beneficiaries. Peer Review Improvement Act, PL 97-248, 1982.
Purchasers are provided information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. The focus is on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. (from http://www.ahrq.gov/qual/meyerrpt.htm accessed 11/25/2011)
The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.
The period of confinement of a patient to a hospital or other health facility.
The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.
Customer satisfaction or dissatisfaction with a benefit or service received.
The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.
Revenues or receipts accruing from business enterprise, labor, or invested capital.
Economic aspects of the field of medicine, the medical profession, and health care. It includes the economic and financial impact of disease in general on the patient, the physician, society, or government.
Health care provided to individuals.
Hospitals owned and operated by a corporation or an individual that operate on a for-profit basis, also referred to as investor-owned hospitals.
Prepaid health and hospital insurance plan.
A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.
Individuals whose ancestral origins are in the continent of Europe.
That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.
Federal, state, or local government organized methods of financial assistance.
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!
Hospitals providing medical care to veterans of wars.
PL97-248. Title II of the Act specifies "provisions relating to savings in health and income security programs." This includes changes in payment for services, benefits and premiums of Medicare as well as changes in provisions under Medicaid and other specific programs covered by Social Security. Title II includes various revenue measures.

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs. (1/2846)

OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement.  (+info)

Organizational and environmental factors associated with nursing home participation in managed care. (2/2846)

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services.  (+info)

Use of out-of-plan services by Medicare members of HIP. (3/2846)

Use of out-of-plan services in 1972 by Medicare members of the Health Insurance Plan of Greater New York (HIP) is examined in terms of the demographic and enrollment characteristics of out-of-plan users, types of services received outside the plan, and the relationship of out-of-plan to in-plan use. Users of services outside the plan tended to be more seriously ill and more frequently hospitalized than those receiving all of their services within the plan. The costs to the SSA of providing medical care to HIP enrollees are compared with analogous costs for non-HIP beneficiaries, and the implications for the organization and financing of health services for the aged are discussed.  (+info)

The changing elderly population and future health care needs. (4/2846)

The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term care services, and on improved coordination between Medicare and Medicaid initiatives. This paper reviews various trends, including the growth in managed-care approaches, experience with social health maintenance organizations and Program of All-Inclusive Care for the Elderly demonstrations, and the need for a coherent long-term care policy. Such policies, however, transcend health care and require a broad range of community initiatives.  (+info)

Hospitals and managed care: catching up with the networks. (5/2846)

Although the growth of managed care is having a significant impact on hospitals, organizational response to managed care remains fragmented. We conducted a survey of 83 hospitals nationwide that indicated that most hospitals now have at least one person devoted to managed care initiatives. These individuals, however, often spend most of their time on current issues, such as contracting with managed care organizations and physician relations. Concerns for the future, such as network development and marketing, although important, receive less immediate attention form these individuals. Hospital managed care executives must take a more proactive role in long range managed care planning by collaborating with managed care organizations and pharmaceutical companies.  (+info)

Differences in physician compensation for cardiovascular services by age, sex, and race. (6/2846)

The purpose was to determine whether physicians receive substantially less compensation from patient groups (women, older patients, and nonwhite patients) that are reported to have low rates of utilization of cardiovascular services. Over an 18-month period we collected information on payments to physicians by 3,194 consecutive patients who underwent stress testing an 833 consecutive patients who underwent percutaneous coronary angioplasty at the Yale University Cardiology Practice. Although the charges for procedures were not related to patient characteristics, there were large and significant differences in payment to physicians based on age, sex, and race. For example, physicians who performed percutaneous transluminal coronary angioplasty received at least $2,500 from, or on behalf of, 72% of the patients 40 to 64 years old, 22% of the patients 65 to 74 years old, and 3% of the patients 75 years and older (P < 0.001); from 49% of the men and 28% of the women (P < 0.001); and 42% of the whites and 31% of the nonwhites (P < 0.001). Similar differences were observed for stress testing. These associations were largely explained by differences in insurance status.  (+info)

Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program. (7/2846)

Adverse drug reactions and inappropriate prescribing practices are an important cause of hospitalization, morbidity, and mortality in the elderly. This study compares prescribing practices within a Medicare risk contract health maintenance organization (HMO) in 1993 and 1994 with prescribing practices for two nationally representative samples of elderly individuals predominantly receiving medical care within the Medicare fee-for-service sector. Information on prescriptions in the fee-for-service sector came from the 1987 National Medical Expenditures Survey (NMES) and the 1992 Medicare Current Beneficiary Survey (MCBS). A total of 20 drugs were studied; these drugs were deemed inappropriate for the elderly because their risk of causing adverse events exceeded their health benefits, according to a consensus panel of experts in geriatrics and pharmacology. One or more of the 20 potentially inappropriate drugs was prescribed to 11.53% of the Medicare HMO members in 1994. These medications were prescribed significantly less often to HMO members in 1994 than to individuals in the fee-for-service sector, based on information from both the 1987 NMES and the 1992 MCBS. Utilization of unsafe or ineffective medications actually decreased with increasing age in the HMO sample, with lowest rates in individuals over the age of 85. However, no relationship between age and medication use was seen in the NMES study, except for individuals over the age of 90 years. The study data support the conclusion that ineffective or unsafe medications were prescribed less often in the Medicare HMO than in national comparison groups. In fact, for the very old, who are most at risk, the use of these medications was much lower in the Medicare HMO than in the Medicare fee-for-service sector. Nevertheless, in 1994, approximately one of every nine members of this Medicare HMO received at least one such medication. Continued efforts and innovative strategies to further reduce the use of unsafe and ineffective drugs among elderly Medicare HMO members are needed.  (+info)

Medicare HMOs: who joins and who leaves? (8/2846)

Medicare risk health maintenance organizations (HMOs) are an increasingly common alternative to fee-for-service Medicare. To date, there has been no examination of whether the HMO program is preferentially used by blacks or by persons living in lower-income areas or whether race and income are associated with reversing Medicare HMO selection. This question is important because evidence suggests that these beneficiaries receive poorer care under the fee-for-service-system than do whites and persons from wealthier areas. Medicare enrollment data from South Florida were examined for 1990 to 1993. Four overlapping groups of enrollees were examined: all age-eligible (age 65 and over) beneficiaries in 1990; all age-eligible beneficiaries in 1993; all age-eligible beneficiaries residing in South Florida during the period 1990 to 1993; and all beneficiaries who became age-eligible for Medicare benefits between 1990 and 1993. The associations between race or income and choice of Medicare option were examined by logistic regression. The association between the demographic characteristics and time staying with a particular option was examined with Kaplan-Meier methods and Cox Proportional Hazards modeling. Enrollment in Medicare risk HMOs steadily increased over the 4-year study period. In the overall Medicare population, the following statistically significant patterns of enrollment in Medicare HMOs were seen: enrollment of blacks was two times higher than that of non-blacks; enrollment decreased with age; and enrollment decreased as income level increased. For the newly eligible population, initial selection of Medicare option was strongly linked to income; race effects were weak but statistically significant. The data for disenrollment from an HMO revealed a similar demographic pattern. At 6 months, higher percentages of blacks, older beneficiaries (older than 85), and individuals from the lowest income area (less than $15,000 per year) had disenrolled. A small percentage of beneficiaries moved between HMOs and FFS plans multiple times. These data on Medicare HMO populations in South Florida, an area with a high concentration of elderly individuals and with one of the highest HMO enrollment rates in the country, indicate that enrollment into and disenrollment from Medicare risk HMOs are associated with certain demographic characteristics, specifically, black race or residence in a low-income area.  (+info)

Medicare is a social insurance program in the United States, administered by the Centers for Medicare & Medicaid Services (CMS), that provides health insurance coverage to people who are aged 65 and over; or who have certain disabilities; or who have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

The program consists of four parts:

1. Hospital Insurance (Part A), which helps pay for inpatient care in hospitals, skilled nursing facilities, hospices, and home health care.
2. Medical Insurance (Part B), which helps pay for doctors' services, outpatient care, medical supplies, and preventive services.
3. Medicare Advantage Plans (Part C), which are private insurance plans that provide all of your Part A and Part B benefits, and may include additional benefits like dental, vision, and hearing coverage.
4. Prescription Drug Coverage (Part D), which helps pay for medications doctors prescribe for treatment.

Medicare is funded by payroll taxes, premiums paid by beneficiaries, and general revenue. Beneficiaries typically pay a monthly premium for Part B and Part D coverage, while Part A is generally free for those who have worked and paid Medicare taxes for at least 40 quarters.

Medicare Part B is the component of Medicare, a federal health insurance program in the United States, that covers medically necessary outpatient services and preventive services. These services include doctor visits, laboratory tests, diagnostic imaging, durable medical equipment, mental health services, ambulance services, and some home health care services.

Medicare Part B also covers certain preventive services such as cancer screenings, vaccinations, and wellness visits to help maintain an individual's health and prevent illnesses or diseases from getting worse. It is financed through a combination of monthly premiums paid by enrollees and funds from the federal government's general revenue. Enrollment in Medicare Part B is voluntary, but there are penalties for not enrolling when first eligible, unless an individual has creditable coverage from another source.

Medicare Part A is the hospital insurance component of Medicare, which is a federal health insurance program in the United States. Specifically, Part A helps cover the costs associated with inpatient care in hospitals, skilled nursing facilities, and some types of home health care. This can include things like semi-private rooms, meals, nursing services, and any other necessary hospital services and supplies.

Part A coverage also extends to hospice care for individuals who are terminally ill and have a life expectancy of six months or less. In this case, Part A helps cover the costs associated with hospice care, including pain management, symptom control, and emotional and spiritual support for both the patient and their family.

It's important to note that Medicare Part A is not completely free, as most people do not pay a monthly premium for this coverage. However, there are deductibles and coinsurance costs associated with using Part A services, which can vary depending on the specific service being provided.

I'm sorry for any confusion, but "United States" is a geopolitical entity, specifically the name of the country consisting of 50 states, and it is not a medical term or concept. Therefore, I can't provide a medical definition for it. If you have any questions related to health, medicine, or biology, I would be happy to try to help answer those!

Fee-for-service (FFS) plans are a type of medical reimbursement model in which healthcare providers are paid for each specific service or procedure they perform. In this system, the patient or their insurance company is charged separately for each appointment, test, or treatment, and the provider receives payment based on the number and type of services delivered.

FFS plans can be either traditional fee-for-service or modified fee-for-service. Traditional FFS plans offer providers more autonomy in setting their fees but may lead to higher healthcare costs due to potential overutilization of services. Modified FFS plans, on the other hand, involve pre-negotiated rates between insurance companies and healthcare providers, aiming to control costs while still allowing providers to be compensated for each service they deliver.

It is important to note that FFS plans can sometimes create financial incentives for healthcare providers to perform more tests or procedures than necessary, potentially leading to increased healthcare costs and potential overtreatment. As a result, alternative payment models like capitation, bundled payments, and value-based care have emerged as alternatives to address these concerns.

Pharmaceutical services insurance refers to a type of coverage that helps individuals and families pay for their prescription medications. This type of insurance is often offered as part of a larger health insurance plan, but can also be purchased as a standalone policy.

The specifics of pharmaceutical services insurance coverage can vary widely depending on the policy. Some plans may cover only generic medications, while others may cover both brand-name and generic drugs. Additionally, some policies may require individuals to pay a portion of the cost of their prescriptions in the form of copays or coinsurance, while others may cover the full cost of medications.

Pharmaceutical services insurance can be especially important for individuals who have chronic medical conditions that require ongoing treatment with expensive prescription medications. By helping to offset the cost of these medications, pharmaceutical services insurance can make it easier for people to afford the care they need to manage their health and improve their quality of life.

Reimbursement mechanisms in a medical context refer to the various systems and methods used by health insurance companies, government agencies, or other payers to refund or recompense healthcare providers, institutions, or patients for the costs associated with medical services, treatments, or products. These mechanisms ensure that covered individuals receive necessary medical care while protecting payers from unnecessary expenses.

There are several types of reimbursement mechanisms, including:

1. Fee-for-service (FFS): In this model, healthcare providers are paid for each service or procedure they perform, with the payment typically based on a predetermined fee schedule. This can lead to overutilization and increased costs if providers perform unnecessary services to increase their reimbursement.
2. Capitation: Under capitation, healthcare providers receive a set amount of money per patient enrolled in their care for a specified period, regardless of the number or type of services provided. This encourages providers to manage resources efficiently and focus on preventive care to maintain patients' health and reduce overall costs.
3. Bundled payments: Also known as episode-based payment, this model involves paying a single price for all the services related to a specific medical event, treatment, or condition over a defined period. This encourages coordination among healthcare providers and can help eliminate unnecessary procedures and costs.
4. Resource-Based Relative Value Scale (RBRVS): RBRVS is a payment system that assigns relative value units (RVUs) to various medical services based on factors such as time, skill, and intensity required for the procedure. The RVUs are then converted into a monetary amount using a conversion factor. This system aims to create more equitable and consistent payments across different medical specialties and procedures.
5. Prospective payment systems (PPS): In PPS, healthcare providers receive predetermined fixed payments for specific services or conditions based on established diagnosis-related groups (DRGs) or other criteria. This system encourages efficiency in care delivery and can help control costs by setting limits on reimbursement amounts.
6. Pay-for-performance (P4P): P4P models tie a portion of healthcare providers' reimbursements to their performance on specific quality measures, such as patient satisfaction scores or adherence to evidence-based guidelines. This system aims to incentivize high-quality care and improve overall healthcare outcomes.
7. Shared savings/risk arrangements: In these models, healthcare providers form accountable care organizations (ACOs) or other collaborative entities that assume responsibility for managing the total cost of care for a defined population. If they can deliver care at lower costs while maintaining quality standards, they share in the savings with payers. However, if costs exceed targets, they may be required to absorb some of the financial risk.

These various reimbursement models aim to balance the need for high-quality care with cost control and efficiency in healthcare delivery. By aligning incentives and promoting coordination among providers, these systems can help improve patient outcomes while reducing unnecessary costs and waste in the healthcare system.

Insurance benefits refer to the coverage, payments or services that a health insurance company provides to its policyholders based on the terms of their insurance plan. These benefits can include things like:

* Payment for all or a portion of medical services, such as doctor visits, hospital stays, and prescription medications
* Coverage for specific treatments or procedures, such as cancer treatment or surgery
* Reimbursement for out-of-pocket expenses, such as deductibles, coinsurance, and copayments
* Case management and care coordination services to help policyholders navigate the healthcare system and receive appropriate care.

The specific benefits provided will vary depending on the type of insurance plan and the level of coverage purchased by the policyholder. It is important for individuals to understand their insurance benefits and how they can access them in order to make informed decisions about their healthcare.

A Prospective Payment System (PPS) is a method of reimbursement in which the payment for a specific service is determined before the service is provided. It is commonly used in healthcare systems, including hospitals and post-acute care facilities, to control costs and promote efficiency. Under this system, providers are paid a predetermined amount based on the patient's diagnosis or the type of procedure being performed, rather than being reimbursed for each individual service provided. This encourages providers to deliver care in the most cost-effective manner possible while still meeting quality standards. The Centers for Medicare and Medicaid Services (CMS) uses PPS for many of its payment models, including the Inpatient Prospective Payment System (IPPS) and the Outpatient Prospective Payment System (OPPS).

An insurance claim review is the process conducted by an insurance company to evaluate a claim made by a policyholder for coverage of a loss or expense. This evaluation typically involves examining the details of the claim, assessing the damages or injuries incurred, verifying the coverage provided by the policy, and determining the appropriate amount of benefits to be paid. The insurance claim review may also include investigating the circumstances surrounding the claim to ensure its validity and confirming that it complies with the terms and conditions of the insurance policy.

Health expenditures refer to the total amount of money spent on health services, goods, and resources in a given period. This can include expenses for preventive care, medical treatments, medications, long-term care, and administrative costs. Health expenditures can be made by individuals, corporations, insurance companies, or governments, and they can be measured at the national, regional, or household level.

Health expenditures are often used as an indicator of a country's investment in its healthcare system and can reflect the overall health status of a population. High levels of health expenditures may indicate a strong commitment to healthcare, but they can also place a significant burden on individuals, businesses, and governments. Understanding patterns and trends in health expenditures is important for policymakers, healthcare providers, and researchers who are working to improve the efficiency, effectiveness, and accessibility of healthcare services.

Medicare Payment Advisory Commission (MedPAC) is not a medical term itself, but it is a federal advisory commission that provides recommendations to Congress on issues affecting the Medicare program. According to the official MedPAC website, its mission is "to advise Congress on payments to providers in Medicare's fee-for-service and managed care programs."

MedPAC is an independent agency established by the Balanced Budget Act of 1997 (BBA) and is composed of 17 commissioners appointed by the Comptroller General, with representatives from the medical community, including practicing doctors and nurses, as well as other health care experts, economists, and consumer advocates.

MedPAC's primary responsibility is to analyze access to care, quality of care, and other issues affecting Medicare beneficiaries and providers. The commission then makes recommendations to Congress on payment updates, payment system reforms, and policies aimed at improving the efficiency and effectiveness of the Medicare program. These recommendations cover various aspects of Medicare, including payments for hospitals, physicians, skilled nursing facilities, home health agencies, hospice care, and other healthcare services.

In summary, MedPAC is a federal advisory commission that provides non-partisan analysis and recommendations to Congress on Medicare payment policies and issues affecting the program's beneficiaries and providers.

Medigap, also known as Medicare Supplement Insurance, is a type of insurance policy sold by private companies that helps cover costs not paid for by Original Medicare (Part A and Part B), such as deductibles, copayments, and coinsurance. Medigap policies are standardized and come in different plans labeled with letters (A, B, C, D, F, G, K, L, M, N). Each plan offers a different level of coverage, but all plans cover at least 50% of the Part A deductible. It's important to note that Medigap policies do not include coverage for prescription drugs, and separate Medicare Prescription Drug Plans (Part D) must be purchased if desired. Additionally, individuals cannot have both a Medigap policy and a Medicare Advantage plan at the same time.

Insurance coverage, in the context of healthcare and medicine, refers to the financial protection provided by an insurance policy that covers all or a portion of the cost of medical services, treatments, and prescription drugs. The coverage is typically offered by health insurance companies, employers, or government programs such as Medicare and Medicaid.

The specific services and treatments covered by insurance, as well as the out-of-pocket costs borne by the insured individual, are determined by the terms of the insurance policy. These terms may include deductibles, copayments, coinsurance, and coverage limits or exclusions. The goal of insurance coverage is to help individuals manage the financial risks associated with healthcare expenses and ensure access to necessary medical services.

Medicaid is a joint federal-state program that provides health coverage for low-income individuals, including children, pregnant women, elderly adults, and people with disabilities. Eligibility, benefits, and administration vary by state, but the program is designed to ensure that low-income individuals have access to necessary medical services. Medicaid is funded jointly by the federal government and the states, and is administered by the states under broad federal guidelines.

Medicaid programs must cover certain mandatory benefits, such as inpatient and outpatient hospital services, laboratory and X-ray services, and physician services. States also have the option to provide additional benefits, such as dental care, vision services, and prescription drugs. In addition, many states have expanded their Medicaid programs to cover more low-income adults under the Affordable Care Act (ACA).

Medicaid is an important source of health coverage for millions of Americans, providing access to necessary medical care and helping to reduce financial burden for low-income individuals.

A fee schedule in a medical context refers to a list of fees that healthcare providers charge for various procedures, services, or treatments. It is essentially a price list that outlines the cost of each service offered by the healthcare provider. Fee schedules can be established by individual practitioners, hospitals, clinics, or insurance networks and may vary based on factors such as location, specialty, and complexity of the procedure.

In some cases, fee schedules are negotiated between healthcare providers and insurance companies to determine the allowed amount for reimbursement. This helps ensure that patients receive consistent and predictable pricing for medical services while also allowing healthcare providers to maintain a sustainable practice. Additionally, fee schedules can help patients understand their financial responsibilities before undergoing medical procedures or treatments.

"Rate setting and review" is not a commonly used medical term with a specific definition in the field. However, I can provide you with information about what these terms might refer to in a broader healthcare context:

Rate setting generally refers to the process of determining the payment rates for healthcare services, programs, or products. This could involve setting reimbursement rates for medical procedures, medications, or durable medical equipment under government-funded health insurance programs like Medicare and Medicaid, or in the private insurance sector. Rate setting can be influenced by various factors, including the cost of providing care, resource utilization, quality metrics, and market competition.

Review, in this context, typically refers to the process of evaluating and assessing healthcare services, programs, or products to ensure their quality, effectiveness, and efficiency. This could involve reviewing medical records, clinical outcomes, and financial data to determine if the care provided is consistent with evidence-based guidelines, industry best practices, and regulatory requirements. Regular reviews are essential for maintaining high standards of care, identifying areas for improvement, and ensuring that resources are allocated efficiently.

Together, "rate setting and review" may refer to a comprehensive approach to managing healthcare costs and quality by establishing appropriate payment rates while continuously monitoring and improving the effectiveness and efficiency of healthcare services.

Eligibility determination is the process of evaluating whether an individual meets the required criteria or conditions to be qualified for a particular program, benefit, service, or position. This process typically involves assessing various factors such as medical condition, functional abilities, financial status, age, and other relevant aspects based on the specific eligibility requirements.

In the context of healthcare and medical services, eligibility determination is often used to establish whether a patient qualifies for certain treatments, insurance coverage, government assistance programs (like Medicaid or Medicare), or disability benefits. This process may include reviewing medical records, conducting assessments, and comparing the individual's situation with established guidelines or criteria.

The primary goal of eligibility determination is to ensure that resources are allocated fairly and appropriately to those who genuinely need them and meet the necessary requirements.

Hospital economics refers to the study and application of economic principles and concepts in the management and operation of hospitals and healthcare organizations. This field examines issues such as cost containment, resource allocation, financial management, reimbursement systems, and strategic planning. The goal of hospital economics is to improve the efficiency and effectiveness of hospital operations while maintaining high-quality patient care. It involves understanding and analyzing various economic factors that affect hospitals, including government regulations, market forces, technological advancements, and societal values. Hospital economists may work in a variety of settings, including hospitals, consulting firms, academic institutions, and government agencies.

Cost sharing in a medical or healthcare context refers to the portion of health care costs that are paid by the patient or health plan member, rather than by their insurance company. Cost sharing can take various forms, including deductibles, coinsurance, and copayments.

A deductible is the amount that a patient must pay out of pocket for medical services before their insurance coverage kicks in. For example, if a health plan has a $1,000 deductible, the patient must pay the first $1,000 of their medical expenses before their insurance starts covering costs.

Coinsurance is the percentage of medical costs that a patient is responsible for paying after they have met their deductible. For example, if a health plan has 20% coinsurance, the patient would pay 20% of the cost of medical services, and their insurance would cover the remaining 80%.

Copayments are fixed amounts that patients must pay for specific medical services, such as doctor visits or prescription medications. Copayments are typically paid at the time of service and do not count towards a patient's deductible.

Cost sharing is intended to encourage patients to be more cost-conscious in their use of healthcare services, as they have a financial incentive to seek out lower-cost options. However, high levels of cost sharing can also create barriers to accessing necessary medical care, particularly for low-income individuals and families.

Skilled Nursing Facilities (SNFs) are healthcare facilities that provide round-the-clock skilled nursing care and medical supervision to individuals who require rehabilitation or long-term care. These facilities are designed for patients who need more medical attention and assistance with activities of daily living than can be provided at home or in an assisted living facility.

SNFs offer a wide range of services, including:

1. Skilled nursing care: Registered nurses (RNs) and licensed practical nurses (LPNs) provide 24-hour medical care and monitoring for patients with complex medical needs.
2. Rehabilitation services: Physical, occupational, and speech therapists work with patients to help them regain strength, mobility, and communication skills after an illness, injury, or surgery.
3. Medical management: SNFs have a team of healthcare professionals, such as physicians, nurse practitioners, and pharmacists, who collaborate to manage each patient's medical needs and develop individualized care plans.
4. Nutritional support: Registered dietitians assess patients' nutritional needs and provide specialized diets and feeding assistance when necessary.
5. Social services: Case managers and social workers help patients and their families navigate the healthcare system, coordinate discharge planning, and connect them with community resources.
6. Personal care: Certified nursing assistants (CNAs) provide assistance with activities of daily living, such as bathing, dressing, grooming, and using the bathroom.
7. Therapeutic recreation: Recreational therapists offer activities designed to improve patients' physical, cognitive, and emotional well-being.

SNFs may be standalone facilities or part of a larger healthcare system, such as a hospital or continuing care retirement community (CCRC). To qualify for Medicare coverage in an SNF, individuals must have a qualifying hospital stay of at least three days and need skilled nursing or rehabilitation services. Medicaid and private insurance may also cover the cost of care in Skilled Nursing Facilities.

In the context of medical law and ethics, fraud refers to a deliberate and intentional deception or misrepresentation of facts, motivated by personal gain, which is made by a person or entity in a position of trust, such as a healthcare professional or organization. This deception can occur through various means, including the provision of false information, the concealment of important facts, or the manipulation of data.

Medical fraud can take many forms, including:

1. Billing fraud: This occurs when healthcare providers submit false claims to insurance companies or government programs like Medicare and Medicaid for services that were not provided, were unnecessary, or were more expensive than the services actually rendered.
2. Prescription fraud: Healthcare professionals may engage in prescription fraud by writing unnecessary prescriptions for controlled substances, such as opioids, for their own use or to sell on the black market. They may also alter prescriptions or use stolen identities to obtain these drugs.
3. Research fraud: Scientists and researchers can commit fraud by manipulating or falsifying data in clinical trials, experiments, or studies to support predetermined outcomes or to secure funding and recognition.
4. Credentialing fraud: Healthcare professionals may misrepresent their qualifications, licenses, or certifications to gain employment or admitting privileges at healthcare facilities.
5. Identity theft: Stealing someone's personal information to obtain medical services, prescription medications, or insurance benefits is another form of medical fraud.

Medical fraud not only has severe legal consequences for those found guilty but also undermines the trust between patients and healthcare providers, jeopardizes patient safety, and contributes to rising healthcare costs.

The Patient Protection and Affordable Care Act (ACA) is a comprehensive healthcare reform law passed in 2010 in the United States. Its primary goal is to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals, businesses, and government.

The ACA achieves these goals through several key provisions:

1. Individual mandate: Requires most individuals to have health insurance or pay a penalty, with some exceptions.
2. Employer mandate: Requires certain employers to offer health insurance to their employees or face penalties.
3. Insurance market reforms: Prohibits insurers from denying coverage based on pre-existing conditions, limits out-of-pocket costs, and requires coverage of essential health benefits.
4. Medicaid expansion: Expands Medicaid eligibility to cover more low-income individuals and families.
5. Health insurance exchanges: Establishes state-based marketplaces where individuals and small businesses can purchase qualified health plans.
6. Subsidies: Provides premium tax credits and cost-sharing reductions to help eligible individuals and families afford health insurance.
7. Prevention and public health fund: Invests in prevention, wellness, and public health programs.
8. Medicare reforms: Improves benefits for Medicare beneficiaries, reduces costs for some beneficiaries, and extends the solvency of the Medicare Trust Fund.

The ACA has been subject to numerous legal challenges and political debates since its passage. Despite these controversies, the law has significantly reduced the number of uninsured Americans and reshaped the U.S. healthcare system.

"Competitive bidding" is not a medical term, but rather a business or procurement concept that can be applied in various industries, including healthcare. In the context of healthcare, competitive bidding typically refers to a process where healthcare providers or suppliers submit bids to provide goods or services to a payer, such as a government agency or insurance company, at the lowest possible price.

The goal of competitive bidding is to promote cost savings and efficiency in the delivery of healthcare services. For example, Medicare uses a competitive bidding program for certain medical equipment and supplies, such as wheelchairs and oxygen equipment, where suppliers submit bids and are awarded contracts based on their ability to provide high-quality items at the lowest price.

However, it's important to note that while competitive bidding can lead to cost savings, it may also have unintended consequences, such as reducing provider participation or limiting access to certain services in some areas. Therefore, it is essential to balance cost savings with quality and access considerations when implementing competitive bidding programs in healthcare.

"Insurance Selection Bias" is not a widely recognized medical term. However, in the context of health services research and health economics, "selection bias" generally refers to the distortion of study results due to the non-random selection of individuals into different groups, such as treatment and control groups. In the context of health insurance, selection bias may occur when individuals who choose to enroll in a particular insurance plan have different characteristics (such as age, health status, or income) than those who do not enroll, leading to biased estimates of the plan's effectiveness or cost.

For example, if healthier individuals are more likely to choose a particular insurance plan because it has lower premiums, while sicker individuals are more likely to choose a different plan with more comprehensive coverage, then any comparison of health outcomes or costs between the two plans may be biased due to the differences in the health status of the enrollees.

Therefore, researchers must take steps to control for selection bias in their analyses, such as adjusting for confounding variables or using statistical methods like propensity score matching to create more comparable groups.

Insurance claim reporting is the process of informing an insurance company about a potential claim that an insured individual or business intends to make under their insurance policy. This report typically includes details about the incident or loss, such as the date, time, location, and type of damage or injury, as well as any relevant documentation, such as police reports or medical records.

The purpose of insurance claim reporting is to initiate the claims process and provide the insurance company with the necessary information to evaluate the claim and determine coverage. The insured individual or business may be required to submit additional information or evidence to support their claim, and the insurance company will conduct an investigation to assess the validity and value of the claim.

Prompt and accurate reporting of insurance claims is important to ensure that the claim is processed in a timely manner and to avoid any potential delays or denials of coverage based on late reporting. It is also important to provide complete and truthful information during the claims process, as misrepresentations or false statements can lead to claim denials or even fraud investigations.

A capitation fee is a payment model in healthcare systems where physicians or other healthcare providers receive a set amount of money per patient assigned to their care, per period of time, whether or not that patient seeks care. This fee is intended to cover all the necessary medical services for that patient during that time frame. It is a type of risk-based payment model that encourages providers to manage resources efficiently and provide appropriate care to keep patients healthy and avoid unnecessary procedures or hospitalizations. The amount of the capitation fee can vary based on factors such as the patient's age, health status, and any specific healthcare needs they may have.

Cost savings in a medical context generally refers to the reduction in expenses or resources expended in the delivery of healthcare services, treatments, or procedures. This can be achieved through various means such as implementing more efficient processes, utilizing less expensive treatment options when appropriate, preventing complications or readmissions, and negotiating better prices for drugs or supplies.

Cost savings can also result from comparative effectiveness research, which compares the relative benefits and harms of different medical interventions to help doctors and patients make informed decisions about which treatment is most appropriate and cost-effective for a given condition.

Ultimately, cost savings in healthcare aim to improve the overall value of care delivered by reducing unnecessary expenses while maintaining or improving quality outcomes for patients.

Diagnosis-Related Groups (DRGs) are a system of classifying hospital patients based on their severity of illness, resource utilization, and other factors. DRGs were developed by the US federal government to determine the relative cost of providing inpatient care for various types of diagnoses and procedures.

The DRG system categorizes patients into one of several hundred groups based on their diagnosis, treatment, and other clinical characteristics. Each DRG has a corresponding payment weight that reflects the average resource utilization and costs associated with caring for patients in that group. Hospitals are then reimbursed for inpatient services based on the DRG payment weights, providing an incentive to provide more efficient and cost-effective care.

DRGs have been widely adopted as a tool for managing healthcare costs and improving quality of care. They are used by Medicare, Medicaid, and many private insurers to determine payments for inpatient hospital services. DRGs can also be used to compare the performance of hospitals and healthcare providers, identify best practices, and support quality improvement initiatives.

"Reimbursement, Incentive" is not a standard medical term, but I can provide an explanation based on the individual terms:

1. Reimbursement: This refers to the act of paying back or giving compensation for expenses that have already been incurred. In a medical context, this often relates to insurance companies reimbursing patients or healthcare providers for the costs of medical services or supplies after they have been paid.
2. Incentive: An incentive is a motivating factor that encourages someone to do something. In healthcare, incentives can be used to encourage patients to make healthier choices or to participate in certain programs. They can also be used to motivate healthcare providers to follow best practices or to improve the quality of care they provide.

Therefore, "Reimbursement, Incentive" could refer to a payment made after the fact to compensate for expenses incurred, with the added intention of encouraging certain behaviors or actions. For example, an insurance company might offer to reimburse patients for the cost of gym memberships as an incentive to encourage them to exercise regularly.

Managed care programs are a type of health insurance plan that aims to control healthcare costs and improve the quality of care by managing the utilization of healthcare services. They do this by using a network of healthcare providers who have agreed to provide services at reduced rates, and by implementing various strategies such as utilization review, case management, and preventive care.

In managed care programs, there is usually a primary care physician (PCP) who acts as the patient's main doctor and coordinates their care within the network of providers. Patients may need a referral from their PCP to see specialists or access certain services. Managed care programs can take various forms, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point-of-Service (POS) plans, and Exclusive Provider Organizations (EPOs).

The goal of managed care programs is to provide cost-effective healthcare services while maintaining or improving the quality of care. They can help patients save money on healthcare costs by providing coverage for a range of services at lower rates than traditional fee-for-service plans, but they may also limit patient choice and require prior authorization for certain procedures or treatments.

Health care reform refers to the legislative efforts, initiatives, and debates aimed at improving the quality, affordability, and accessibility of health care services. These reforms may include changes to health insurance coverage, delivery systems, payment methods, and healthcare regulations. The goals of health care reform are often to increase the number of people with health insurance, reduce healthcare costs, and improve the overall health outcomes of a population. Examples of notable health care reform measures in the United States include the Affordable Care Act (ACA) and Medicare for All proposals.

Health services research (HSR) is a multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of care, and ultimately, our health and well-being. The goal of HSR is to inform policy and practice, improve system performance, and enhance the health and well-being of individuals and communities. It involves the use of various research methods, including epidemiology, biostatistics, economics, sociology, management science, political science, and psychology, to answer questions about the healthcare system and how it can be improved.

Examples of HSR topics include:

* Evaluating the effectiveness and cost-effectiveness of different healthcare interventions and technologies
* Studying patient-centered care and patient experiences with the healthcare system
* Examining healthcare workforce issues, such as shortages of primary care providers or the impact of nurse-to-patient ratios on patient outcomes
* Investigating the impact of health insurance design and financing systems on access to care and health disparities
* Analyzing the organization and delivery of healthcare services in different settings, such as hospitals, clinics, and long-term care facilities
* Identifying best practices for improving healthcare quality and safety, reducing medical errors, and eliminating wasteful or unnecessary care.

Health care costs refer to the expenses incurred for medical services, treatments, procedures, and products that are used to maintain or restore an individual's health. These costs can be categorized into several types:

1. Direct costs: These include payments made for doctor visits, hospital stays, medications, diagnostic tests, surgeries, and other medical treatments and services. Direct costs can be further divided into two subcategories:
* Out-of-pocket costs: Expenses paid directly by patients, such as co-payments, deductibles, coinsurance, and any uncovered medical services or products.
* Third-party payer costs: Expenses covered by insurance companies, government programs (like Medicare, Medicaid), or other entities that pay for health care services on behalf of patients.
2. Indirect costs: These are the expenses incurred as a result of illness or injury that indirectly impact an individual's ability to work and earn a living. Examples include lost productivity, absenteeism, reduced earning capacity, and disability benefits.
3. Non-medical costs: These are expenses related to caregiving, transportation, home modifications, assistive devices, and other non-medical services required for managing health conditions or disabilities.

Health care costs can vary significantly depending on factors such as the type of medical service, geographic location, insurance coverage, and individual health status. Understanding these costs is essential for patients, healthcare providers, policymakers, and researchers to make informed decisions about treatment options, resource allocation, and health system design.

"Financial Risk Sharing" in a medical context generally refers to the allocation of financial risk between parties involved in the provision, financing, or coverage of healthcare services. This can include arrangements such as capitation payments, where healthcare providers receive a set amount of money per patient enrolled in their care, regardless of the number of services provided; or reinsurance, where insurance companies share the risk of large claims with other insurers. The goal of financial risk sharing is to create incentives for efficient and cost-effective care while also protecting against unexpectedly high costs.

Personal Financing is not a term that has a specific medical definition. However, in general terms, it refers to the management of an individual's financial resources, such as income, assets, liabilities, and debts, to meet their personal needs and goals. This can include budgeting, saving, investing, planning for retirement, and managing debt.

In the context of healthcare, personal financing may refer to the ability of individuals to pay for their own medical care expenses, including health insurance premiums, deductibles, co-pays, and out-of-pocket costs. This can be a significant concern for many people, particularly those with chronic medical conditions or disabilities who may face ongoing healthcare expenses.

Personal financing for healthcare may involve various strategies, such as setting aside savings, using health savings accounts (HSAs) or flexible spending accounts (FSAs), purchasing health insurance policies with lower premiums but higher out-of-pocket costs, or negotiating payment plans with healthcare providers. Ultimately, personal financing for healthcare involves making informed decisions about how to allocate financial resources to meet both immediate and long-term medical needs while also balancing other financial goals and responsibilities.

Cost allocation is the process of distributing or assigning costs to different departments, projects, products, or services within an organization. The goal of cost allocation is to more accurately determine the true cost of producing a product or providing a service, taking into account all related expenses. This can help organizations make better decisions about pricing, resource allocation, and profitability analysis.

There are various methods for allocating costs, including activity-based costing (ABC), which assigns costs based on the activities required to produce a product or provide a service; traditional costing, which uses broad categories such as direct labor, direct materials, and overhead; and causal allocation, which assigns costs based on a specific cause-and-effect relationship.

In healthcare, cost allocation is particularly important for determining the true cost of patient care, including both direct and indirect costs. This can help hospitals and other healthcare organizations make informed decisions about resource allocation, pricing, and reimbursement strategies.

Cost control in a medical context refers to the strategies and practices employed by healthcare organizations to manage and reduce the costs associated with providing patient care while maintaining quality and safety. The goal is to optimize resource allocation, increase efficiency, and contain expenses without compromising the standard of care. This may involve measures such as:

1. Utilization management: Reviewing and monitoring the use of medical services, tests, and treatments to ensure they are necessary, appropriate, and evidence-based.
2. Case management: Coordinating patient care across various healthcare providers and settings to improve outcomes, reduce unnecessary duplication of services, and control costs.
3. Negotiating contracts with suppliers and vendors to secure favorable pricing for medical equipment, supplies, and pharmaceuticals.
4. Implementing evidence-based clinical guidelines and pathways to standardize care processes and reduce unwarranted variations in practice that can drive up costs.
5. Using technology such as electronic health records (EHRs) and telemedicine to streamline operations, improve communication, and reduce errors.
6. Investing in preventive care and wellness programs to keep patients healthy and reduce the need for costly interventions and hospitalizations.
7. Continuously monitoring and analyzing cost data to identify trends, opportunities for improvement, and areas of potential waste or inefficiency.

Economic competition in the context of healthcare and medicine generally refers to the rivalry among healthcare providers, organizations, or pharmaceutical companies competing for patients, resources, market share, or funding. This competition can drive innovation, improve quality of care, and increase efficiency. However, it can also lead to cost-containment measures that may negatively impact patient care and safety.

In the pharmaceutical industry, economic competition exists between different companies developing and marketing similar drugs. This competition can result in lower prices for consumers and incentives for innovation, but it can also lead to unethical practices such as price gouging or misleading advertising.

Regulation and oversight are crucial to ensure that economic competition in healthcare and medicine promotes the well-being of patients and the public while discouraging harmful practices.

Relative Value Scale (RVS) is a system used in the United States to determine the payment rate for medical services provided under the Medicare program. The RVS assigns a relative value unit (RVU) to each service based on three components:

1. Work RVUs - reflecting the physician's time, skill, and effort required to perform the service.
2. Practice expense RVUs - covering the costs of operating a medical practice, such as rent, equipment, and supplies.
3. Malpractice RVUs - accounting for the cost of malpractice insurance associated with each procedure.

The total relative value unit (RVU) assigned to a service is then multiplied by a conversion factor to determine the payment amount. The Centers for Medicare & Medicaid Services (CMS) sets the conversion factor annually, and it can vary based on geographic location.

It's important to note that while RVS provides a standardized framework for determining payment rates, there are ongoing debates about its accuracy and fairness in compensating physicians for the services they provide.

A prescription fee is not a medical definition per se, but rather a term used in the context of pharmacy and healthcare services. It refers to the charge for dispensing a medication that has been prescribed by a healthcare professional. The prescription fee may cover the cost of the medication itself, as well as any additional services provided by the pharmacist, such as counseling on how to take the medication, potential side effects, and monitoring requirements.

Prescription fees may vary depending on the location, the type of medication, and the healthcare system in place. In some cases, prescription fees may be covered or subsidized by health insurance plans, while in other cases, patients may be responsible for paying the fee out of pocket. It is important for patients to understand their prescription coverage and any associated costs before filling a prescription.

Risk adjustment is a statistical method used in healthcare financing and delivery to account for differences in the health status and expected healthcare costs among groups of enrollees. It is a process that modifies payment rates or capitation amounts based on the relative risk of each enrollee, as measured by demographic factors such as age, sex, and chronic medical conditions. The goal of risk adjustment is to create a more level playing field for healthcare providers and insurers by reducing the financial impact of serving patients who are sicker or have greater healthcare needs. This allows for a more fair comparison of performance and payment across different populations and helps to ensure that resources are distributed equitably.

"Drug costs" refer to the amount of money that must be paid to acquire and use a particular medication. These costs can include the following:

1. The actual purchase price of the drug, which may vary depending on factors such as the dosage form, strength, and quantity of the medication, as well as whether it is obtained through a retail pharmacy, mail-order service, or other distribution channel.
2. Any additional fees or charges associated with obtaining the drug, such as shipping and handling costs, insurance copayments or coinsurance amounts, and deductibles.
3. The cost of any necessary medical services or supplies that are required to administer the drug, such as syringes, needles, or alcohol swabs for injectable medications, or nebulizers for inhaled drugs.
4. The cost of monitoring and managing any potential side effects or complications associated with the use of the drug, which may include additional medical appointments, laboratory tests, or other diagnostic procedures.

It is important to note that drug costs can vary widely depending on a variety of factors, including the patient's insurance coverage, the pharmacy where the drug is obtained, and any discounts or rebates that may be available. Patients are encouraged to shop around for the best prices and to explore all available options for reducing their out-of-pocket costs, such as using generic medications or participating in manufacturer savings programs.

In medical terminology, a budget is not explicitly defined. However, in a general sense, it refers to a financial plan that outlines the anticipated costs and expenses for a specific period. In healthcare, budgets can be used by hospitals, clinics, or other medical facilities to plan for and manage their finances.

A healthcare organization's budget may include expenses related to:

* Salaries and benefits for staff
* Equipment and supply costs
* Facility maintenance and improvements
* Research and development expenses
* Insurance and liability coverage
* Marketing and advertising costs

Budgets can help healthcare organizations manage their finances effectively, allocate resources efficiently, and make informed decisions about spending. They may also be used to plan for future growth and expansion.

A surgicenter, also known as an ambulatory surgery center (ASC), is a specialized healthcare facility that provides same-day surgical procedures. These facilities are equipped with operating rooms and recovery rooms but do not have beds for overnight stays. Surgicenters primarily focus on providing outpatient surgeries, which allow patients to recover at home instead of being admitted to a hospital.

Procedures performed at surgicenters typically include minor to intermediate-complexity surgeries such as:

1. Orthopedic procedures (e.g., arthroscopy, joint repairs)
2. Ophthalmologic procedures (e.g., cataract surgery, LASIK)
3. Pain management procedures (e.g., epidural steroid injections)
4. Dental surgery
5. Endoscopies and colonoscopies
6. Plastic and reconstructive surgeries
7. Gynecologic procedures

Surgicenters offer several advantages, including lower costs compared to hospital-based surgeries, increased convenience for patients, reduced risk of infection due to shorter stays, and a more personalized care experience. They are often affiliated with hospitals or medical groups and must adhere to strict regulations and accreditation standards to ensure patient safety and quality of care.

Quality of health care is a term that refers to the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. It encompasses various aspects such as:

1. Clinical effectiveness: The use of best available evidence to make decisions about prevention, diagnosis, treatment, and care. This includes considering the benefits and harms of different options and making sure that the most effective interventions are used.
2. Safety: Preventing harm to patients and minimizing risks associated with healthcare. This involves identifying potential hazards, implementing measures to reduce errors, and learning from adverse events to improve systems and processes.
3. Patient-centeredness: Providing care that is respectful of and responsive to individual patient preferences, needs, and values. This includes ensuring that patients are fully informed about their condition and treatment options, involving them in decision-making, and providing emotional support throughout the care process.
4. Timeliness: Ensuring that healthcare services are delivered promptly and efficiently, without unnecessary delays. This includes coordinating care across different providers and settings to ensure continuity and avoid gaps in service.
5. Efficiency: Using resources wisely and avoiding waste, while still providing high-quality care. This involves considering the costs and benefits of different interventions, as well as ensuring that healthcare services are equitably distributed.
6. Equitability: Ensuring that all individuals have access to quality healthcare services, regardless of their socioeconomic status, race, ethnicity, gender, age, or other factors. This includes addressing disparities in health outcomes and promoting fairness and justice in healthcare.

Overall, the quality of health care is a multidimensional concept that requires ongoing evaluation and improvement to ensure that patients receive the best possible care.

Hospice care is a type of medical care and support provided to individuals who are terminally ill, with a life expectancy of six months or less, and have decided to stop curative treatments. The goal of hospice care is to provide comfort, dignity, and quality of life for the patient, as well as emotional and spiritual support for both the patient and their family members during the end-of-life process.

Hospice care services typically include pain management, symptom control, nursing care, emotional and spiritual counseling, social work services, volunteer support, and respite care for caregivers. These services can be provided in various settings such as the patient's home, a hospice facility, or a hospital. The interdisciplinary team of healthcare professionals works together to develop an individualized plan of care that addresses the unique needs and preferences of each patient and their family members.

The primary focus of hospice care is on improving the quality of life for patients with advanced illnesses by managing their symptoms, alleviating pain, and providing emotional and spiritual support. Hospice care also aims to help patients maintain their independence and dignity while allowing them to spend their remaining time in a familiar and comfortable environment, surrounded by loved ones.

Medical fees are the charges for services provided by medical professionals and healthcare facilities. These fees can vary widely depending on the type of service, the provider, and the geographic location. They may include charges for office visits, procedures, surgeries, hospital stays, diagnostic tests, and prescribed medications. In some cases, medical fees may be covered in part or in full by health insurance, but in other cases patients may be responsible for paying these fees out of pocket. It is important for patients to understand the fees associated with their medical care and to ask questions about any charges that they do not understand.

I am not a medical professional, but I can tell you that the term "contract services" is more commonly used in business and healthcare administration than in clinical medicine. It generally refers to an agreement between a healthcare provider or organization and another entity for the delivery of specific medical services over a defined period of time. The contract outlines the scope, expectations, and compensation for these services.

For example, a hospital may have a contract with a staffing agency to provide nursing personnel on a temporary basis. Or, an insurance company might have a contract with a network of healthcare providers to deliver medical care to their policyholders at agreed-upon rates. These arrangements can help ensure consistent quality and cost control in the delivery of healthcare services.

"Marketing of Health Services" refers to the application of marketing principles and strategies to promote, sell, and deliver health care services to individuals, families, or communities. This can include activities such as advertising, public relations, promotions, and sales to increase awareness and demand for health services, as well as researching and analyzing consumer needs and preferences to tailor health services to better meet those needs. The ultimate goal of marketing in health services is to improve access to and utilization of high-quality health care while maintaining ethical standards and ensuring patient satisfaction.

A hospital is a healthcare facility where patients receive medical treatment, diagnosis, and care for various health conditions, injuries, or diseases. It is typically staffed with medical professionals such as doctors, nurses, and other healthcare workers who provide round-the-clock medical services. Hospitals may offer inpatient (overnight) stays or outpatient (same-day) services, depending on the nature of the treatment required. They are equipped with various medical facilities like operating rooms, diagnostic equipment, intensive care units (ICUs), and emergency departments to handle a wide range of medical situations. Hospitals may specialize in specific areas of medicine, such as pediatrics, geriatrics, oncology, or trauma care.

Current Procedural Terminology (CPT) is a system of medical codes, developed and maintained by the American Medical Association (AMA), that are used to describe medical, surgical, and diagnostic services provided by healthcare professionals. The codes are used for administrative purposes, such as billing and insurance claims processing, and consist of a five-digit alphanumeric code that identifies the specific service or procedure performed.

The CPT code set is organized into three categories: Category I codes describe common medical, surgical, and diagnostic services; Category II codes are used for performance measurement and tracking of quality improvement initiatives; and Category III codes are used for emerging technologies, experimental procedures, and services that do not have a defined CPT code.

Healthcare professionals and facilities rely on the accuracy and specificity of CPT codes to ensure appropriate reimbursement for their services. The AMA regularly updates the CPT code set to reflect changes in medical practice and technology, and provides guidance and resources to help healthcare professionals navigate the complexities of coding and billing.

The Surveillance, Epidemiology, and End Results (SEER) Program is not a medical condition or diagnosis, but rather a research program run by the National Cancer Institute (NCI), which is part of the National Institutes of Health (NIH). The SEER Program collects and publishes cancer incidence and survival data from population-based cancer registries covering approximately 34.6% of the U.S. population.

The primary goal of the SEER Program is to provide reliable, up-to-date, and accessible information about cancer incidence and survival in the United States. This information is used by researchers, clinicians, policymakers, and the public to monitor cancer trends, identify factors that influence cancer risk, inform cancer prevention and control efforts, and improve cancer care.

The SEER Program collects data on patient demographics, primary tumor site, morphology, stage at diagnosis, first course of treatment, and survival. The program also supports research on the causes and effects of cancer, as well as the development of new methods for cancer surveillance and data analysis.

Fees and charges in a medical context refer to the costs that patients are required to pay for healthcare services, treatments, or procedures. These may include:

1. Professional fees: The amount charged by healthcare professionals such as doctors, nurses, or therapists for their time, expertise, and services provided during consultations, examinations, or treatments.

2. Hospital charges: The costs associated with a patient's hospital stay, including room and board, nursing care, medications, and diagnostic tests.

3. Facility fees: Additional charges levied by hospitals, clinics, or ambulatory surgery centers to cover the overhead expenses of maintaining the facility and its equipment.

4. Procedure or treatment-specific fees: Costs directly related to specific medical procedures, surgeries, or treatments, such as anesthesia, radiology services, laboratory tests, or surgical supplies.

5. Ancillary fees: Additional costs for items like crutches, slings, or durable medical equipment that patients may need during their recovery process.

6. Insurance copayments, coinsurance, and deductibles: The portion of healthcare expenses that patients are responsible for paying based on their insurance policy terms.

It is essential for patients to understand the fees and charges associated with their medical care to make informed decisions about their treatment options and manage their healthcare costs effectively.

Physician Self-Referral, also known as the Stark Law, is a federal regulation that prohibits physicians from referring their patients to certain healthcare services or providers with whom they have a financial relationship, unless an exception applies. The law is designed to prevent conflicts of interest and ensure that physician referrals are based on the patient's medical needs rather than financial considerations.

The Stark Law covers designated health services (DHS) such as clinical laboratory services, physical therapy, radiology, radiation therapy, durable medical equipment, home health services, outpatient prescription drugs, and inpatient and outpatient hospital services. It applies to referrals made by physicians who have a financial relationship with the DHS entity, such as ownership, investment, or compensation arrangements.

Violations of the Stark Law can result in significant civil penalties, including fines and exclusion from federal healthcare programs. However, there are several exceptions to the law, such as in-office ancillary services, rural provider exceptions, and academic medical center exceptions, among others. It is essential for physicians and healthcare providers to understand and comply with the Stark Law and its exceptions to avoid legal and financial consequences.

I'm sorry for any confusion, but "Models, Econometric" is not a medical term. Econometric models are statistical tools used in the field of economics to estimate economic relationships and forecast future outcomes. They are based on economic theory and use historical data to estimate the parameters of mathematical equations that describe these relationships.

If you have any questions about medical terms or concepts, I'd be happy to try to help! Just let me know what you're looking for.

Health services accessibility refers to the degree to which individuals and populations are able to obtain needed health services in a timely manner. It includes factors such as physical access (e.g., distance, transportation), affordability (e.g., cost of services, insurance coverage), availability (e.g., supply of providers, hours of operation), and acceptability (e.g., cultural competence, language concordance).

According to the World Health Organization (WHO), accessibility is one of the key components of health system performance, along with responsiveness and fair financing. Improving accessibility to health services is essential for achieving universal health coverage and ensuring that everyone has access to quality healthcare without facing financial hardship. Factors that affect health services accessibility can vary widely between and within countries, and addressing these disparities requires a multifaceted approach that includes policy interventions, infrastructure development, and community engagement.

A nursing home, also known as a skilled nursing facility, is a type of residential healthcare facility that provides round-the-clock care and assistance to individuals who require a high level of medical care and support with activities of daily living. Nursing homes are designed for people who cannot be cared for at home or in an assisted living facility due to their complex medical needs, mobility limitations, or cognitive impairments.

Nursing homes provide a range of services, including:

1. Skilled nursing care: Registered nurses and licensed practical nurses provide 24-hour medical care and monitoring for residents with chronic illnesses, disabilities, or those recovering from surgery or illness.
2. Rehabilitation services: Physical, occupational, and speech therapists help residents regain strength, mobility, and communication skills after an injury, illness, or surgery.
3. Personal care: Certified nursing assistants (CNAs) help residents with activities of daily living, such as bathing, dressing, grooming, and using the bathroom.
4. Meals and nutrition: Nursing homes provide three meals a day, plus snacks, and accommodate special dietary needs.
5. Social activities: Recreational programs and social events are organized to help residents stay active and engaged with their peers.
6. Hospice care: Some nursing homes offer end-of-life care for residents who require palliative or comfort measures.
7. Secure environments: For residents with memory impairments, specialized units called memory care or Alzheimer's units provide a secure and structured environment to help maintain their safety and well-being.

When selecting a nursing home, it is essential to consider factors such as the quality of care, staff-to-resident ratio, cleanliness, and overall atmosphere to ensure the best possible experience for the resident.

Health care surveys are research tools used to systematically collect information from a population or sample regarding their experiences, perceptions, and knowledge of health services, health outcomes, and various other health-related topics. These surveys typically consist of standardized questionnaires that cover specific aspects of healthcare, such as access to care, quality of care, patient satisfaction, health disparities, and healthcare costs. The data gathered from health care surveys are used to inform policy decisions, improve healthcare delivery, identify best practices, allocate resources, and monitor the health status of populations. Health care surveys can be conducted through various modes, including in-person interviews, telephone interviews, mail-in questionnaires, or online platforms.

Hospitalization is the process of admitting a patient to a hospital for the purpose of receiving medical treatment, surgery, or other health care services. It involves staying in the hospital as an inpatient, typically under the care of doctors, nurses, and other healthcare professionals. The length of stay can vary depending on the individual's medical condition and the type of treatment required. Hospitalization may be necessary for a variety of reasons, such as to receive intensive care, to undergo diagnostic tests or procedures, to recover from surgery, or to manage chronic illnesses or injuries.

Costs refer to the total amount of resources, such as money, time, and labor, that are expended in the provision of a medical service or treatment. Costs can be categorized into direct costs, which include expenses directly related to patient care, such as medication, supplies, and personnel; and indirect costs, which include overhead expenses, such as rent, utilities, and administrative salaries.

Cost analysis is the process of estimating and evaluating the total cost of a medical service or treatment. This involves identifying and quantifying all direct and indirect costs associated with the provision of care, and analyzing how these costs may vary based on factors such as patient volume, resource utilization, and reimbursement rates.

Cost analysis is an important tool for healthcare organizations to understand the financial implications of their operations and make informed decisions about resource allocation, pricing strategies, and quality improvement initiatives. It can also help policymakers and payers evaluate the cost-effectiveness of different treatment options and develop evidence-based guidelines for clinical practice.

A drug prescription is a written or electronic order provided by a licensed healthcare professional, such as a physician, dentist, or advanced practice nurse, to a pharmacist that authorizes the preparation and dispensing of a specific medication for a patient. The prescription typically includes important information such as the patient's name and date of birth, the name and strength of the medication, the dosage regimen, the duration of treatment, and any special instructions or precautions.

Prescriptions serve several purposes, including ensuring that patients receive the appropriate medication for their medical condition, preventing medication errors, and promoting safe and effective use of medications. They also provide a legal record of the medical provider's authorization for the pharmacist to dispense the medication to the patient.

There are two main types of prescriptions: written prescriptions and electronic prescriptions. Written prescriptions are handwritten or printed on paper, while electronic prescriptions are transmitted electronically from the medical provider to the pharmacy. Electronic prescriptions are becoming increasingly common due to their convenience, accuracy, and security.

It is important for patients to follow the instructions provided on their prescription carefully and to ask their healthcare provider or pharmacist any questions they may have about their medication. Failure to follow a drug prescription can result in improper use of the medication, which can lead to adverse effects, treatment failure, or even life-threatening situations.

Hospital costs are the total amount of money that is expended by a hospital to provide medical and healthcare services to patients. These costs can include expenses related to:

* Hospital staff salaries and benefits
* Supplies, such as medications, medical devices, and surgical equipment
* Utilities, such as electricity, water, and heating
* Facility maintenance and renovation
* Equipment maintenance and purchase
* Administrative costs, such as billing and insurance processing

Hospital costs can also be classified into fixed and variable costs. Fixed costs are those that do not change with the volume of services provided, such as rent or depreciation of equipment. Variable costs are those that change with the volume of services provided, such as supplies and medications.

It's important to note that hospital costs can vary widely depending on factors such as the complexity of care provided, the geographic location of the hospital, and the patient population served. Additionally, hospital costs may not always align with charges or payments for healthcare services, which can be influenced by factors such as negotiated rates with insurance companies and government reimbursement policies.

'Drug legislation' refers to the laws and regulations that govern the production, distribution, sale, possession, and use of medications and pharmaceutical products within a given jurisdiction. These laws are designed to protect public health and safety by establishing standards for drug quality, ensuring appropriate prescribing and dispensing practices, preventing drug abuse and diversion, and promoting access to necessary medications. Drug legislation may also include provisions related to clinical trials, advertising, packaging, labeling, and reimbursement. Compliance with these regulations is typically enforced through a combination of government agencies, professional organizations, and legal penalties for non-compliance.

Pharmaceutical fees are charges that healthcare professionals or institutions may impose on patients for various services related to the prescribing and dispensing of medications. These fees can include costs associated with medication therapy management, drug monitoring, medication reconciliation, and other clinical services provided by pharmacists or other healthcare providers.

It's important to note that these fees are separate from the cost of the medication itself and may not be covered by insurance. Patients should always ask about any potential fees before receiving pharmaceutical services and clarify whether they will be responsible for paying them out-of-pocket.

Retrospective studies, also known as retrospective research or looking back studies, are a type of observational study that examines data from the past to draw conclusions about possible causal relationships between risk factors and outcomes. In these studies, researchers analyze existing records, medical charts, or previously collected data to test a hypothesis or answer a specific research question.

Retrospective studies can be useful for generating hypotheses and identifying trends, but they have limitations compared to prospective studies, which follow participants forward in time from exposure to outcome. Retrospective studies are subject to biases such as recall bias, selection bias, and information bias, which can affect the validity of the results. Therefore, retrospective studies should be interpreted with caution and used primarily to generate hypotheses for further testing in prospective studies.

Financial management in a hospital setting refers to the planning, organizing, directing, and controlling of financial resources in order to achieve the hospital's mission, vision, and strategic objectives. This includes developing financial strategies, preparing budget plans, managing revenue cycles, controlling costs, ensuring compliance with financial regulations, and making informed decisions about resource allocation. Effective financial management is critical for the sustainability and growth of hospitals, as it enables them to provide high-quality patient care while maintaining fiscal responsibility.

Patient readmission refers to the event when a patient who was previously discharged from a hospital or healthcare facility returns for further treatment, often within a specified period. It is measured as a percentage of patients who are readmitted within a certain time frame, such as 30, 60, or 90 days after discharge. Readmissions may be planned or unplanned and can occur due to various reasons, including complications from the initial illness or treatment, inadequate post-discharge follow-up care, or the patient's inability to manage their health conditions effectively at home. High readmission rates are often considered an indicator of the quality of care provided during the initial hospitalization and may also signify potential issues with care coordination and transitions between healthcare settings.

Economic models in the context of healthcare and medicine are theoretical frameworks used to analyze and predict the economic impact and cost-effectiveness of healthcare interventions, treatments, or policies. These models utilize clinical and epidemiological data, as well as information on resource use and costs, to estimate outcomes such as quality-adjusted life years (QALYs) gained, incremental cost-effectiveness ratios (ICERs), and budget impacts. The purpose of economic models is to inform decision-making and allocate resources in an efficient and evidence-based manner. Examples of economic models include decision tree analysis, Markov models, and simulation models.

I apologize for the confusion, but "inflation" is an economic term and not a medical one. Here's a simple explanation of what it means:

Economic inflation is a rise in the general price level of goods and services in an economy over a period of time. When the overall prices of these items increase, each unit of currency buys fewer goods and services; consequently, inflation reflects a reduction in the purchasing power of money – a loss of real value in the medium of exchange and unit of account within an economic system. This is typically measured by the Consumer Price Index (CPI) or the Producer Price Index (PPI), and central banks attempt to limit inflation, and avoid deflation, in order to keep the economy running smoothly.

Prescription drugs are medications that are only available to patients with a valid prescription from a licensed healthcare professional, such as a doctor or nurse practitioner. These drugs cannot be legally obtained over-the-counter and require a prescription due to their potential for misuse, abuse, or serious side effects. They are typically used to treat complex medical conditions, manage symptoms of chronic illnesses, or provide necessary pain relief in certain situations.

Prescription drugs are classified based on their active ingredients and therapeutic uses. In the United States, the Drug Enforcement Administration (DEA) categorizes them into five schedules (I-V) depending on their potential for abuse and dependence. Schedule I substances have the highest potential for abuse and no accepted medical use, while schedule V substances have a lower potential for abuse and are often used for legitimate medical purposes.

Examples of prescription drugs include opioid painkillers like oxycodone and hydrocodone, stimulants such as Adderall and Ritalin, benzodiazepines like Xanax and Ativan, and various other medications used to treat conditions such as epilepsy, depression, anxiety, and high blood pressure.

It is essential to use prescription drugs only as directed by a healthcare professional, as misuse or abuse can lead to severe health consequences, including addiction, overdose, and even death.

I'm sorry for any confusion, but "privatization" is not a term that has a specific medical definition. Privatization generally refers to the process of transferring ownership, control, or management of a previously publicly owned or controlled entity, industry, or service to private hands. This concept can apply to various sectors, including healthcare services and institutions, but it does not have a unique medical meaning.

The Health Care Sector is a segment of the economy that includes companies and organizations that provide goods and services to treat patients with medical conditions, as well as those that work to maintain people's health through preventative care and health education. This sector includes hospitals, clinics, physician practices, dental practices, pharmacies, home health care agencies, nursing homes, laboratories, and medical device manufacturers, among others.

The Health Care Sector is often broken down into several subsectors, including:

1. Providers of healthcare services, such as hospitals, clinics, and physician practices.
2. Payers of healthcare costs, such as insurance companies and government agencies like Medicare and Medicaid.
3. Manufacturers of healthcare products, such as medical devices, pharmaceuticals, and biotechnology products.
4. Distributors of healthcare products, such as wholesalers and pharmacy benefit managers.
5. Providers of healthcare information technology, such as electronic health record systems and telemedicine platforms.

The Health Care Sector is a significant contributor to the economy in many countries, providing employment opportunities and contributing to economic growth. However, it also faces significant challenges, including rising costs, an aging population, and increasing demands for access to high-quality care.

Home care services, also known as home health care, refer to a wide range of health and social services delivered at an individual's residence. These services are designed to help people who have special needs or disabilities, those recovering from illness or surgery, and the elderly or frail who require assistance with activities of daily living (ADLs) or skilled nursing care.

Home care services can include:

1. Skilled Nursing Care: Provided by registered nurses (RNs), licensed practical nurses (LPNs), or licensed vocational nurses (LVNs) to administer medications, wound care, injections, and other medical treatments. They also monitor the patient's health status, provide education on disease management, and coordinate with other healthcare professionals.
2. Therapy Services: Occupational therapists, physical therapists, and speech-language pathologists help patients regain strength, mobility, coordination, balance, and communication skills after an illness or injury. They develop personalized treatment plans to improve the patient's ability to perform daily activities independently.
3. Personal Care/Assistance with Activities of Daily Living (ADLs): Home health aides and personal care assistants provide assistance with bathing, dressing, grooming, toileting, and other personal care tasks. They may also help with light housekeeping, meal preparation, and shopping.
4. Social Work Services: Provided by licensed social workers who assess the patient's psychosocial needs, connect them to community resources, and provide counseling and support for patients and their families.
5. Nutritional Support: Registered dietitians evaluate the patient's nutritional status, develop meal plans, and provide education on special diets or feeding techniques as needed.
6. Telehealth Monitoring: Remote monitoring of a patient's health status using technology such as video conferencing, wearable devices, or mobile apps to track vital signs, medication adherence, and symptoms. This allows healthcare providers to monitor patients closely and adjust treatment plans as necessary without requiring in-person visits.
7. Hospice Care: End-of-life care provided in the patient's home to manage pain, provide emotional support, and address spiritual needs. The goal is to help the patient maintain dignity and quality of life during their final days.
8. Respite Care: Temporary relief for family caregivers who need a break from caring for their loved ones. This can include short-term stays in assisted living facilities or hiring professional caregivers to provide in-home support.

Subacute care is a level of medical care and support that is provided to patients who are in stable condition but still require close monitoring and treatment for complex medical issues, including wound care, pain management, and rehabilitation services. This type of care is typically provided in specialized units of hospitals, skilled nursing facilities, or standalone subacute care centers.

Subacute care is less intensive than acute care, which is provided to patients who are experiencing a severe illness or injury that requires immediate attention and constant monitoring. At the same time, subacute care is more complex and comprehensive than traditional long-term care services, such as those provided in nursing homes.

The goal of subacute care is to help patients recover from their medical issues and regain their independence and functionality as much as possible. This type of care typically involves a team of healthcare professionals, including doctors, nurses, therapists, and social workers, who work together to develop an individualized plan of care for each patient.

Examples of conditions that may require subacute care include:

* Complex wounds that require specialized treatment and monitoring
* Post-surgical recovery from major surgery or transplants
* Recovery from stroke or other neurological disorders
* Ventilator weaning for patients who no longer need acute care but are not yet ready to breathe on their own
* Management of chronic conditions, such as diabetes or heart failure, that require close monitoring and adjustment of medications.

A hospice is a specialized type of healthcare facility or program that provides palliative care and support for people who are experiencing a serious, life-limiting illness and have a prognosis of six months or less to live. The goal of hospice care is to improve the quality of life for patients and their families by managing symptoms, providing emotional and spiritual support, and helping patients and their loved ones navigate the end-of-life process with dignity and comfort.

Hospice care can be provided in a variety of settings, including hospitals, nursing homes, assisted living facilities, and private homes. The services offered by hospices may include medical care, pain management, nursing care, social work services, counseling, spiritual support, and volunteer services. Hospice care is typically covered by Medicare, Medicaid, and most private insurance plans.

It's important to note that choosing hospice care does not mean giving up hope or stopping treatment for a patient's illness. Instead, it means shifting the focus of care from curative treatments to comfort measures that can help patients live as fully and comfortably as possible in the time they have left.

Health Insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons. By purchasing health insurance, insured individuals pay a premium to an insurance company, which then pools those funds with other policyholders' premiums to pay for the medical care costs of individuals who become ill or injured. The coverage can include hospitalization, medical procedures, prescription drugs, and preventive care, among other services. The goal of health insurance is to provide financial protection against unexpected medical expenses and to make healthcare services more affordable.

The United States Department of Health and Human Services (HHS) is not a medical term per se, but it is a government organization that oversees and provides funding for many public health initiatives, services, and institutions in the United States. Here's a brief definition:

The HHS is a cabinet-level department in the US federal government responsible for protecting the health of all Americans and providing essential human services. It achieves this by promoting effective and efficient delivery of high-quality healthcare, conducting critical medical research through its agencies, such as the National Institutes of Health (NIH), and enforcing public health laws and regulations, including those related to food safety, through its agencies, such as the Food and Drug Administration (FDA). Additionally, HHS oversees the Medicare and Medicaid programs, which provide healthcare coverage for millions of elderly, disabled, and low-income Americans.

A Health Benefit Plan for Employees refers to a type of insurance policy that an employer provides to their employees as part of their benefits package. These plans are designed to help cover the costs of medical care and services for the employees and sometimes also for their dependents. The specific coverage and details of the plan can vary depending on the terms of the policy, but they typically include a range of benefits such as doctor visits, hospital stays, prescription medications, and preventative care. Employers may pay all or part of the premiums for these plans, and employees may also have the option to contribute to the cost of coverage. The goal of health benefit plans for employees is to help protect the financial well-being of workers by helping them manage the costs of medical care.

Accountable Care Organizations (ACOs) are a type of healthcare delivery and payment model that aims to improve the quality, coordination, and efficiency of care for a defined population of patients. The goal of an ACO is to provide comprehensive, coordinated care to patients while also reducing unnecessary costs and utilization.

An ACO typically includes a group of healthcare providers, such as hospitals, physicians, and other clinicians, who work together to provide care for a specific patient population. These providers are held accountable for the overall health outcomes and costs of their patients, incentivizing them to focus on prevention, coordination, and evidence-based medicine.

ACOs often use data analytics and technology to identify high-risk patients, coordinate care across providers, and track performance metrics. They may also receive financial rewards or penalties based on their ability to meet quality and cost targets.

The Centers for Medicare & Medicaid Services (CMS) established the Medicare Shared Savings Program (MSSP) in 2012 as a way to encourage the development of ACOs. Under this program, participating ACOs can earn shared savings payments if they meet certain quality and cost targets for their Medicare beneficiaries.

Overall, Accountable Care Organizations aim to transform the healthcare system by promoting value-based care, improving patient outcomes, and reducing unnecessary costs.

A deductible is a specific amount of money that a patient must pay out of pocket before their health insurance starts covering the costs of medical services. For example, if a patient has a $1000 deductible, they must pay the first $1000 of their medical bills themselves before the insurance begins to cover the remaining costs. Deductibles are annual, meaning they reset every year.

Coinsurance is the percentage of costs for a covered medical service that a patient is responsible for paying after they have met their deductible. For example, if a patient has a 20% coinsurance rate, they will be responsible for paying 20% of the cost of each medical service, while their insurance covers the remaining 80%. Coinsurance rates vary depending on the health insurance plan and the specific medical service being provided.

The United States Department of Veterans Affairs (VA) is not a medical term per se, but it is a government agency that provides medical care and benefits to veterans of the US armed forces. Here's the official definition from the VA's website:

"The US Department of Veterans Affairs (VA) is an independent federal establishment charged with providing federal benefits, services, and healthcare to eligible United States veterans, their dependents, and certain other specified individuals."

The VA operates a vast network of medical centers, clinics, and benefits offices throughout the country, providing a range of services including medical treatment, long-term care, disability compensation, vocational rehabilitation, education assistance, home loan guarantees, and life insurance.

In the context of medicine, the term "ownership" is not typically used as a formal medical definition. However, it may be used informally to refer to the responsibility and authority that a healthcare provider has in managing a patient's care. For example, a physician may say that they "take ownership" of a patient's care, meaning that they will oversee and coordinate all aspects of the patient's medical treatment. Additionally, in medical research or clinical trials, "data ownership" refers to who has the rights to access, use, and share the data collected during the study.

A formulary is a list of prescription drugs, both generic and brand-name, that are approved for use in a specific health plan or healthcare system. The formulary includes information on the preferred drugs within each therapeutic class, along with any restrictions or limitations on their use. Formularies are developed and maintained by a committee of healthcare professionals, including pharmacists and physicians, who evaluate the safety, efficacy, and cost-effectiveness of different medications.

The purpose of a formulary is to promote the appropriate use of medications, improve patient outcomes, and manage healthcare costs. By establishing a preferred list of drugs, health plans and healthcare systems can negotiate better prices with pharmaceutical manufacturers and ensure that patients receive high-quality, evidence-based care.

Formularies may include various types of medications, such as oral solid dosage forms, injectables, inhalants, topicals, and others. They are typically organized by therapeutic class, and each drug is assigned a tier based on its cost and clinical value. Tier 1 drugs are usually preferred generics or lower-cost brand-name medications, while Tier 2 drugs may be higher-cost brand-name medications that have no generic equivalent. Tier 3 drugs are typically specialty medications that are used to treat complex or rare conditions and are often associated with high costs.

Healthcare providers are encouraged to prescribe drugs that are listed on the formulary, as these medications have been thoroughly reviewed and deemed safe and effective for use in their patient population. However, there may be situations where a non-formulary medication is necessary to treat a particular patient's condition. In such cases, healthcare providers can request an exception or prior authorization to prescribe the non-formulary drug.

Formularies are regularly updated to reflect new drugs that come on the market, changes in clinical guidelines, and shifts in the therapeutic landscape. Health plans and healthcare systems may also modify their formularies in response to feedback from patients and providers or to address concerns about safety, efficacy, or cost.

In summary, a formulary is a comprehensive list of prescription drugs that are approved for use in a specific health plan or healthcare system. Formularies promote the appropriate use of medications, improve patient outcomes, and manage costs by encouraging the prescribing of safe and effective drugs that have been thoroughly reviewed and deemed appropriate for their patient population.

"Health services for the aged" is a broad term that refers to medical and healthcare services specifically designed to meet the unique needs of elderly individuals. According to the World Health Organization (WHO), health services for the aged should be "age-friendly" and "person-centered," meaning they should take into account the physical, mental, and social changes that occur as people age, as well as their individual preferences and values.

These services can include a range of medical and healthcare interventions, such as:

* Preventive care, including vaccinations, cancer screenings, and other routine check-ups
* Chronic disease management, such as treatment for conditions like diabetes, heart disease, or arthritis
* Rehabilitation services, such as physical therapy or occupational therapy, to help elderly individuals maintain their mobility and independence
* Palliative care and end-of-life planning, to ensure that elderly individuals receive compassionate and supportive care in their final days
* Mental health services, including counseling and therapy for conditions like depression or anxiety
* Social services, such as transportation assistance, meal delivery, or home care, to help elderly individuals maintain their quality of life and independence.

Overall, the goal of health services for the aged is to promote healthy aging, prevent disease and disability, and provide high-quality, compassionate care to elderly individuals, in order to improve their overall health and well-being.

Long-term care (LTC) is a term used to describe various medical and support services that are required by individuals who need assistance with activities of daily living (such as bathing, dressing, using the toilet) or who have chronic health conditions that require ongoing supervision and care. LTC can be provided in a variety of settings, including nursing homes, assisted living facilities, adult day care centers, and private homes.

The goal of LTC is to help individuals maintain their independence and quality of life for as long as possible, while also ensuring that they receive the necessary medical and support services to meet their needs. LTC can be provided on a short-term or long-term basis, depending on the individual's needs and circumstances.

LTC is often required by older adults who have physical or cognitive limitations, but it can also be needed by people of any age who have disabilities or chronic illnesses that require ongoing care. LTC services may include nursing care, therapy (such as occupational, physical, or speech therapy), personal care (such as help with bathing and dressing), and social activities.

LTC is typically not covered by traditional health insurance plans, but it may be covered by long-term care insurance policies, Medicaid, or other government programs. It's important to plan for LTC needs well in advance, as the cost of care can be significant and can have a major impact on an individual's financial resources.

Healthcare Quality Indicators (QIs) are measurable elements that can be used to assess the quality of healthcare services and outcomes. They are often based on evidence-based practices and guidelines, and are designed to help healthcare providers monitor and improve the quality of care they deliver to their patients. QIs may focus on various aspects of healthcare, such as patient safety, clinical effectiveness, patient-centeredness, timeliness, and efficiency. Examples of QIs include measures such as rates of hospital-acquired infections, adherence to recommended treatments for specific conditions, and patient satisfaction scores. By tracking these indicators over time, healthcare organizations can identify areas where they need to improve, make changes to their processes and practices, and ultimately provide better care to their patients.

Rehabilitation Nursing is a specialized area of nursing practice that focuses on the provision of care to individuals who are recovering from, or living with, a chronic illness, disability, or functional limitation. The goal of rehabilitation nursing is to assist these individuals in achieving and maintaining optimal physical, psychological, social, and vocational functioning, as well as to promote their independence, dignity, and quality of life.

Rehabilitation nurses work collaboratively with other healthcare professionals, such as physicians, therapists, and social workers, to develop and implement individualized care plans that address the unique needs and goals of each patient. They provide a range of services, including assessment and evaluation, education, counseling, and direct care, to help patients acquire or regain skills necessary for daily living, manage symptoms related to their condition, and adjust to any changes in their functional abilities.

Rehabilitation nursing may be provided in a variety of settings, including hospitals, rehabilitation centers, long-term care facilities, and community-based programs. Nurses who specialize in this area typically have advanced training and certification in rehabilitation nursing, and are committed to providing compassionate, patient-centered care that promotes optimal health and well-being.

"Rural Hospital" is a term that refers to a healthcare facility located in a rural area, providing inpatient and outpatient services to people living in those regions. According to the National Rural Health Association, a rural hospital is generally defined as a hospital located in a county with a population density of 100 persons per square mile or less and with a majority of the population (over 50%) living in rural areas.

Rural hospitals often serve as critical access points for healthcare services, offering a broad range of medical care including emergency services, primary care, surgery, obstetrics, and mental health services. They are essential for ensuring that residents of rural communities have access to necessary medical care, especially when considering the challenges associated with longer travel distances and limited availability of healthcare providers in these areas.

Rural hospitals often face unique challenges compared to their urban counterparts, such as financial difficulties due to lower patient volumes, higher rates of uncompensated care, and a greater reliance on Medicare and Medicaid reimbursements. Additionally, rural hospitals may struggle with recruiting and retaining healthcare professionals, which can impact the quality and availability of care for patients in these communities.

Logistic models, specifically logistic regression models, are a type of statistical analysis used in medical and epidemiological research to identify the relationship between the risk of a certain health outcome or disease (dependent variable) and one or more independent variables, such as demographic factors, exposure variables, or other clinical measurements.

In contrast to linear regression models, logistic regression models are used when the dependent variable is binary or dichotomous in nature, meaning it can only take on two values, such as "disease present" or "disease absent." The model uses a logistic function to estimate the probability of the outcome based on the independent variables.

Logistic regression models are useful for identifying risk factors and estimating the strength of associations between exposures and health outcomes, adjusting for potential confounders, and predicting the probability of an outcome given certain values of the independent variables. They can also be used to develop clinical prediction rules or scores that can aid in decision-making and patient care.

An "episode of care" is a term commonly used in the healthcare industry to describe the period of time during which a patient receives medical treatment for a specific condition, injury, or health issue. It typically includes all the services provided by one or more healthcare professionals or facilities during the course of treating that particular condition or health problem. This may include various aspects such as diagnosis, treatment, follow-up care, and any necessary readmissions related to that specific condition.

The purpose of defining an episode of care is to help measure the quality, effectiveness, and cost of healthcare services for a given condition or procedure. By analyzing data from episodes of care, healthcare providers, payers, and policymakers can identify best practices, improve patient outcomes, and make more informed decisions about resource allocation and reimbursement policies.

"Outliers" in the context of Diagnosis-Related Groups (DRGs) refer to cases that are significantly different from other cases within the same DRG category. DRGs are a system used by Medicare and Medicaid to classify hospital cases into payment categories based on severity of illness, resources used, and other factors.

Outliers can be either "inlier" or "outpatient" outliers. Inlier outliers are cases that have significantly longer lengths of stay or higher resource utilization than other cases within the same DRG category, but still fall within certain thresholds. These cases may receive additional payment beyond the standard DRG rate to account for the extra resources used.

Outpatient outliers, on the other hand, are cases that have significantly higher costs than other cases within the same DRG category, even though they may not have longer lengths of stay or higher resource utilization. These cases may also receive additional payment beyond the standard DRG rate to account for the higher costs.

It's important to note that the specific criteria for identifying outliers can vary depending on the payer and the specific rules in place.

Utilization review (UR) is a comprehensive process used by healthcare insurance companies to evaluate the medical necessity, appropriateness, and efficiency of the healthcare services and treatments that have been rendered, are currently being provided, or are being recommended for members. The primary goal of utilization review is to ensure that patients receive clinically necessary and cost-effective care while avoiding unnecessary or excessive treatments.

The utilization review process may involve various steps, including:

1. Preauthorization (also known as precertification): A prospective review to approve or deny coverage for specific services, procedures, or treatments before they are provided. This step helps ensure that the planned care aligns with evidence-based guidelines and medical necessity criteria.
2. Concurrent review: An ongoing evaluation of a patient's treatment during their hospital stay or course of therapy to determine if the services remain medically necessary and consistent with established clinical pathways.
3. Retrospective review: A retrospective analysis of healthcare services already provided to assess their medical necessity, appropriateness, and quality. This step may lead to adjustments in reimbursement or require the provider to justify the rendered services.

Utilization review is typically conducted by a team of healthcare professionals, including physicians, nurses, and case managers, who apply their clinical expertise and adhere to established criteria and guidelines. The process aims to promote high-quality care, reduce wasteful spending, and safeguard patients from potential harm caused by inappropriate or unnecessary treatments.

Health policy refers to a set of decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a population. It is formulated by governmental and non-governmental organizations with the objective of providing guidance and direction for the management and delivery of healthcare services. Health policies address various aspects of healthcare, including access, financing, quality, and equity. They can be designed to promote health, prevent disease, and provide treatment and rehabilitation services to individuals who are sick or injured. Effective health policies require careful consideration of scientific evidence, ethical principles, and societal values to ensure that they meet the needs of the population while being fiscally responsible.

A cohort study is a type of observational study in which a group of individuals who share a common characteristic or exposure are followed up over time to determine the incidence of a specific outcome or outcomes. The cohort, or group, is defined based on the exposure status (e.g., exposed vs. unexposed) and then monitored prospectively to assess for the development of new health events or conditions.

Cohort studies can be either prospective or retrospective in design. In a prospective cohort study, participants are enrolled and followed forward in time from the beginning of the study. In contrast, in a retrospective cohort study, researchers identify a cohort that has already been assembled through medical records, insurance claims, or other sources and then look back in time to assess exposure status and health outcomes.

Cohort studies are useful for establishing causality between an exposure and an outcome because they allow researchers to observe the temporal relationship between the two. They can also provide information on the incidence of a disease or condition in different populations, which can be used to inform public health policy and interventions. However, cohort studies can be expensive and time-consuming to conduct, and they may be subject to bias if participants are not representative of the population or if there is loss to follow-up.

Quality Assurance in the context of healthcare refers to a systematic approach and set of activities designed to ensure that health care services and products consistently meet predetermined standards of quality and safety. It includes all the policies, procedures, and processes that are put in place to monitor, assess, and improve the quality of healthcare delivery.

The goal of quality assurance is to minimize variability in clinical practice, reduce medical errors, and ensure that patients receive evidence-based care that is safe, effective, timely, patient-centered, and equitable. Quality assurance activities may include:

1. Establishing standards of care based on best practices and clinical guidelines.
2. Developing and implementing policies and procedures to ensure compliance with these standards.
3. Providing education and training to healthcare professionals to improve their knowledge and skills.
4. Conducting audits, reviews, and evaluations of healthcare services and processes to identify areas for improvement.
5. Implementing corrective actions to address identified issues and prevent their recurrence.
6. Monitoring and measuring outcomes to evaluate the effectiveness of quality improvement initiatives.

Quality assurance is an ongoing process that requires continuous evaluation and improvement to ensure that healthcare delivery remains safe, effective, and patient-centered.

I must clarify that I'm a helpful assistant and not a doctor, but I can tell you that 'politics' is not a term used in medicine. Politics refers to the activities associated with the governance of a country or area, especially the debate or conflict among individuals or groups having or hoping to achieve power. If you have any medical questions, feel free to ask!

Ambulatory care is a type of health care service in which patients are treated on an outpatient basis, meaning they do not stay overnight at the medical facility. This can include a wide range of services such as diagnosis, treatment, and follow-up care for various medical conditions. The goal of ambulatory care is to provide high-quality medical care that is convenient, accessible, and cost-effective for patients.

Examples of ambulatory care settings include physician offices, community health centers, urgent care centers, outpatient surgery centers, and diagnostic imaging facilities. Patients who receive ambulatory care may have a variety of medical needs, such as routine checkups, chronic disease management, minor procedures, or same-day surgeries.

Overall, ambulatory care is an essential component of modern healthcare systems, providing patients with timely and convenient access to medical services without the need for hospitalization.

Physician's practice patterns refer to the individual habits and preferences of healthcare providers when it comes to making clinical decisions and managing patient care. These patterns can encompass various aspects, such as:

1. Diagnostic testing: The types and frequency of diagnostic tests ordered for patients with similar conditions.
2. Treatment modalities: The choice of treatment options, including medications, procedures, or referrals to specialists.
3. Patient communication: The way physicians communicate with their patients, including the amount and type of information shared, as well as the level of patient involvement in decision-making.
4. Follow-up care: The frequency and duration of follow-up appointments, as well as the monitoring of treatment effectiveness and potential side effects.
5. Resource utilization: The use of healthcare resources, such as hospitalizations, imaging studies, or specialist consultations, and the associated costs.

Physician practice patterns can be influenced by various factors, including medical training, clinical experience, personal beliefs, guidelines, and local availability of resources. Understanding these patterns is essential for evaluating the quality of care, identifying potential variations in care, and implementing strategies to improve patient outcomes and reduce healthcare costs.

High-cost technology in a medical context refers to advanced, specialized healthcare equipment, devices, or treatments that are notably expensive due to factors such as innovative design, extensive research and development investments, scarce resources or expertise required for production, and/or unique clinical applications. These technologies often aim to improve patient outcomes, enhance diagnostic accuracy, or provide minimally invasive treatment options. Examples include advanced imaging systems (e.g., PET/MRI scanners), robotic surgical systems, genomic medicine, and personalized therapies like CAR-T cell treatments for cancer. High-cost technologies may face challenges in healthcare financing, coverage, and accessibility due to their expense.

An inpatient, in medical terms, refers to a person who has been admitted to a hospital or other healthcare facility for the purpose of receiving medical treatment and who is expected to remain there for at least one night. Inpatients are typically cared for by a team of healthcare professionals, including doctors, nurses, and therapists, and may receive various treatments, such as medications, surgeries, or rehabilitation services.

Inpatient care is generally recommended for patients who require close monitoring, frequent assessments, or intensive medical interventions that cannot be provided in an outpatient setting. The length of stay for inpatients can vary widely depending on the nature and severity of their condition, as well as their individual treatment plan.

Patient discharge is a medical term that refers to the point in time when a patient is released from a hospital or other healthcare facility after receiving treatment. This process typically involves the physician or healthcare provider determining that the patient's condition has improved enough to allow them to continue their recovery at home or in another appropriate setting.

The discharge process may include providing the patient with instructions for ongoing care, such as medication regimens, follow-up appointments, and activity restrictions. The healthcare team may also provide educational materials and resources to help patients and their families manage their health conditions and prevent complications.

It is important for patients and their families to understand and follow the discharge instructions carefully to ensure a smooth transition back to home or another care setting and to promote continued recovery and good health.

Data collection in the medical context refers to the systematic gathering of information relevant to a specific research question or clinical situation. This process involves identifying and recording data elements, such as demographic characteristics, medical history, physical examination findings, laboratory results, and imaging studies, from various sources including patient interviews, medical records, and diagnostic tests. The data collected is used to support clinical decision-making, inform research hypotheses, and evaluate the effectiveness of treatments or interventions. It is essential that data collection is performed in a standardized and unbiased manner to ensure the validity and reliability of the results.

"Managed competition" is not a term that has a specific medical or clinical definition. However, it is a concept that is often discussed in the context of healthcare policy and economics. Here's a general definition:

Managed competition is a model for organizing healthcare markets where multiple health plans compete for enrollment, while also being subject to regulatory oversight and quality standards. The goal of managed competition is to promote high-quality care, cost containment, and consumer choice through competition among health plans that are held accountable for their performance.

In a managed competition system, consumers are encouraged to choose among competing health plans based on factors such as price, quality, and provider networks. At the same time, health plans have an incentive to negotiate lower prices with healthcare providers and to invest in preventive care and disease management programs that can improve outcomes and reduce costs over time.

The managed competition model has been implemented in various forms in different countries and regions around the world, including the Netherlands and some U.S. states such as Massachusetts. However, there is ongoing debate about the strengths and limitations of this approach to healthcare reform.

Health services refer to the delivery of healthcare services, including preventive, curative, and rehabilitative services. These services are typically provided by health professionals such as doctors, nurses, and allied health personnel in various settings, including hospitals, clinics, community health centers, and long-term care facilities. Health services may also include public health activities such as health education, surveillance, and health promotion programs aimed at improving the health of populations. The goal of health services is to promote and restore health, prevent disease and injury, and improve the quality of life for individuals and communities.

Home care agencies, also known as home health care agencies, are organizations that provide various health and social services to individuals in their own homes. These services can include skilled nursing care, physical therapy, occupational therapy, speech-language pathology, medical social work, and home health aide services. The goal of home care agencies is to help individuals maintain their independence and quality of life while receiving the necessary care in the comfort of their own homes. Home care agencies must be licensed and regulated by state governments to ensure that they meet certain standards of care.

"Social Security" is a term that refers to a social insurance program, providing financial security to eligible individuals primarily through retirement, disability, and survivor's benefits. In the United States, it is administered by the Social Security Administration (SSA). The program is funded through payroll taxes known as Federal Insurance Contributions Act (FICA) tax, paid by workers and their employers.

It's important to note that "Social Security" is not a medical term per se, but rather a term used in the context of social welfare programs and policies. However, it does have an impact on healthcare as many Americans rely on Social Security benefits to help cover their medical expenses, especially during retirement.

A generic drug is a medication that contains the same active ingredients as an originally marketed brand-name drug, known as its "innovator" or "reference listed" drug. The active ingredient is the component of the drug that is responsible for its therapeutic effect. Generic drugs are required to have the same quality, strength, purity, and stability as their brand-name counterparts. They must also meet the same rigorous Food and Drug Administration (FDA) standards regarding safety, effectiveness, and manufacturing.

Generic drugs are typically less expensive than their brand-name equivalents because generic manufacturers do not have to repeat the costly clinical trials that were required for the innovator drug. Instead, they demonstrate through bioequivalence studies that their product is therapeutically equivalent to the reference listed drug. This means that the generic drug delivers the same amount of active ingredient into a patient's bloodstream in the same timeframe as the brand-name drug.

In summary, generic drugs are copies of brand-name drugs with the same active ingredients, dosage forms, strengths, routes of administration, and intended uses. They must meet FDA regulations for safety, efficacy, and manufacturing standards, ensuring that they provide patients with the same therapeutic benefits as their brand-name counterparts at a more affordable price.

Healthcare disparities refer to differences in the quality, accessibility, and outcomes of healthcare that are systematically related to social or economic disadvantage. These disparities may exist between different racial, ethnic, socioeconomic, gender, sexual orientation, geographic, or disability status groups. They can result from a complex interplay of factors including provider bias, patient-provider communication, health system policies, and structural racism, among others. Healthcare disparities often lead to worse health outcomes and reduced quality of life for disadvantaged populations.

Chiropractic manipulation, also known as spinal manipulative therapy, is a technique used by chiropractors to realign misaligned vertebrae in the spine (subluxations) with the goal of improving function, reducing nerve irritation, and alleviating pain. This technique involves using controlled force, direction, amplitude, and velocity to move joints beyond their passive range of motion but within their physiological limits. The purpose is to restore normal joint motion and function, which can help reduce pain and improve overall health and well-being. It is commonly used to treat musculoskeletal conditions such as low back pain, neck pain, and headaches.

"Age factors" refer to the effects, changes, or differences that age can have on various aspects of health, disease, and medical care. These factors can encompass a wide range of issues, including:

1. Physiological changes: As people age, their bodies undergo numerous physical changes that can affect how they respond to medications, illnesses, and medical procedures. For example, older adults may be more sensitive to certain drugs or have weaker immune systems, making them more susceptible to infections.
2. Chronic conditions: Age is a significant risk factor for many chronic diseases, such as heart disease, diabetes, cancer, and arthritis. As a result, age-related medical issues are common and can impact treatment decisions and outcomes.
3. Cognitive decline: Aging can also lead to cognitive changes, including memory loss and decreased decision-making abilities. These changes can affect a person's ability to understand and comply with medical instructions, leading to potential complications in their care.
4. Functional limitations: Older adults may experience physical limitations that impact their mobility, strength, and balance, increasing the risk of falls and other injuries. These limitations can also make it more challenging for them to perform daily activities, such as bathing, dressing, or cooking.
5. Social determinants: Age-related factors, such as social isolation, poverty, and lack of access to transportation, can impact a person's ability to obtain necessary medical care and affect their overall health outcomes.

Understanding age factors is critical for healthcare providers to deliver high-quality, patient-centered care that addresses the unique needs and challenges of older adults. By taking these factors into account, healthcare providers can develop personalized treatment plans that consider a person's age, physical condition, cognitive abilities, and social circumstances.

Accounts Payable (A/P) and Accounts Receivable (A/R) are terms used in accounting and financial management to refer to the amounts of money a company owes to its creditors (A/P) and the amounts of money owed to the company by its debtors (A/R).

Accounts Payable refers to the liabilities that a company incurs when it purchases goods or services on credit. These are short-term debts that a company is obligated to pay, usually within a specified period of time, such as 30, 60, or 90 days. A/P is listed as a current liability on a company's balance sheet.

Accounts Receivable, on the other hand, refers to the amounts of money owed to a company by its customers for goods or services that have been delivered or used but not yet paid for. A/R is considered an asset because it represents the future economic benefit that will be received when the debtors pay their outstanding balances. A/R is listed as a current asset on a company's balance sheet.

Effective management of A/P and A/R is critical to maintaining a company's financial health, ensuring sufficient cash flow, and avoiding unnecessary expenses or losses due to unpaid debts or missed payment deadlines.

Medication Therapy Management (MTM) is a structured, patient-centered process of care that involves the medication use process for individual patients to optimize therapeutic outcomes and reduce the risk of adverse effects. MTM includes various services such as medication review, identification of potential drug therapy problems, formulation of a personalized care plan, education and counseling, and ongoing monitoring and adjustment of medication therapy. The goal of MTM is to improve medication adherence, enhance patient engagement in their healthcare, and promote the safe and effective use of medications. MTM services may be provided by pharmacists, physicians, nurses, and other healthcare professionals as part of a collaborative care team.

Professional Review Organizations (PROs) are entities that are contracted by the Centers for Medicare and Medicaid Services (CMS) in the United States to evaluate the performance of healthcare providers and suppliers who participate in the Medicare program. PROs conduct medical review activities to ensure that the services billed to Medicare meet the necessary standards of care and are medically necessary.

The primary goal of PROs is to promote quality healthcare, prevent fraud and abuse, and reduce unnecessary costs in the Medicare program. They achieve this by reviewing medical records, conducting site visits, and performing other activities to assess the appropriateness and quality of healthcare services provided to Medicare beneficiaries. Based on their findings, PROs may recommend corrective actions, impose sanctions, or take other measures to ensure that providers comply with Medicare regulations and policies.

PROs are typically composed of practicing physicians and other healthcare professionals who have expertise in the relevant medical specialties. They work collaboratively with CMS and other stakeholders to promote continuous quality improvement in the Medicare program and help ensure that beneficiaries receive high-quality, cost-effective healthcare services.

Value-Based Purchasing (VBP) is a healthcare payment model where providers are paid based on the quality and effectiveness of the care they provide, rather than the quantity of services delivered. This approach aims to incentivize providers to deliver better patient outcomes, improve the overall health of populations, and reduce unnecessary costs.

In VBP, specific performance measures are identified and used to evaluate the quality and efficiency of healthcare services provided by physicians, hospitals, and other healthcare organizations. These measures may include clinical outcomes, patient experience, and patient safety indicators. Providers that perform well on these measures receive higher payments, while those that do not meet the established benchmarks may receive lower payments or face penalties.

The goal of VBP is to create a more efficient and effective healthcare system by aligning financial incentives with high-quality care, promoting evidence-based practices, and fostering greater transparency and accountability in healthcare delivery. Ultimately, this approach aims to improve patient satisfaction, health outcomes, and the overall value derived from healthcare investments.

Drug utilization refers to the use of medications by patients or healthcare professionals in a real-world setting. It involves analyzing and evaluating patterns of medication use, including prescribing practices, adherence to treatment guidelines, potential duplications or interactions, and outcomes associated with drug therapy. The goal of drug utilization is to optimize medication use, improve patient safety, and minimize costs while achieving the best possible health outcomes. It can be studied through various methods such as prescription claims data analysis, surveys, and clinical audits.

"Length of Stay" (LOS) is a term commonly used in healthcare to refer to the amount of time a patient spends receiving care in a hospital, clinic, or other healthcare facility. It is typically measured in hours, days, or weeks and can be used as a metric for various purposes such as resource planning, quality assessment, and reimbursement. The length of stay can vary depending on the type of illness or injury, the severity of the condition, the patient's response to treatment, and other factors. It is an important consideration in healthcare management and can have significant implications for both patients and providers.

Comorbidity is the presence of one or more additional health conditions or diseases alongside a primary illness or condition. These co-occurring health issues can have an impact on the treatment plan, prognosis, and overall healthcare management of an individual. Comorbidities often interact with each other and the primary condition, leading to more complex clinical situations and increased healthcare needs. It is essential for healthcare professionals to consider and address comorbidities to provide comprehensive care and improve patient outcomes.

Consumer satisfaction in a medical context refers to the degree to which a patient or their family is content with the healthcare services, products, or experiences they have received. It is a measure of how well the healthcare delivery aligns with the patient's expectations, needs, and preferences. Factors that contribute to consumer satisfaction may include the quality of care, communication and interpersonal skills of healthcare providers, accessibility and convenience, affordability, and outcomes. High consumer satisfaction is associated with better adherence to treatment plans, improved health outcomes, and higher patient loyalty.

I'm sorry for any confusion, but "policy making" is not a medical term per se. It refers to the process of formulating or establishing official guidelines or rules, such as public policies or organizational policies, that govern decisions and actions. In the context of healthcare, policy making can refer to the development of guidelines, laws, regulations, and procedures that govern the delivery, financing, and accessibility of medical care and health promotion activities.

Examples of policy making in healthcare include:

* Developing clinical practice guidelines for the management of specific medical conditions
* Establishing reimbursement policies for medical procedures or treatments
* Implementing regulations to ensure patient safety and quality of care
* Creating public health policies to address population health issues, such as tobacco control or obesity prevention.

I'm sorry for any confusion, but "income" is not a medical term. Income is an economic term that refers to the inflow of monetary resources or earnings that an individual or household receives from various sources, such as employment, investments, or government benefits. It is typically used in financial and economic contexts rather than medical ones. If you have any questions related to medical terminology or concepts, I would be happy to help with those!

Medical economics is a branch of economics that deals with the application of economic principles and concepts to issues related to health and healthcare. It involves the study of how medical care is produced, distributed, consumed, and financed, as well as the factors that influence these processes. The field encompasses various topics, including the behavior of healthcare providers and consumers, the efficiency and effectiveness of healthcare systems, the impact of health policies on outcomes, and the allocation of resources within the healthcare sector. Medical economists may work in academia, government agencies, healthcare organizations, or consulting firms, contributing to research, policy analysis, and program evaluation.

Personal health services refer to healthcare services that are tailored to an individual's specific needs, preferences, and goals. These services can include preventive care, such as vaccinations and screenings, as well as medical treatments for acute and chronic conditions. Personal health services may be provided by a variety of healthcare professionals, including doctors, nurses, physician assistants, and allied health professionals.

The goal of personal health services is to promote the overall health and well-being of the individual, taking into account their physical, mental, emotional, and social needs. This approach recognizes that each person is unique and requires a customized plan of care to achieve their optimal health outcomes. Personal health services may be delivered in a variety of settings, including hospitals, clinics, private practices, and long-term care facilities.

Proprietary hospitals, also known as private for-profit hospitals, are healthcare institutions that are owned and operated by a private company or individual with the primary goal of generating a profit. These hospitals are funded through patient fees, investments, and other sources of revenue. They are required to meet state and federal regulations regarding patient care and safety but may have more flexibility in making business decisions compared to non-profit or government-owned hospitals.

Blue Cross Blue Shield (BCBS) is a federation of 36 separate health insurance organizations and companies in the United States. It provides healthcare coverage to over 100 million Americans, making it one of the largest health insurers in the country. The BCBS brand offers a variety of medical, dental, vision, and prescription drug plans for individuals, families, and businesses.

The "Blue Cross" and "Blue Shield" designations originated from two separate insurance organizations that emerged in the early 20th century. Blue Cross initially focused on hospital coverage, while Blue Shield concentrated on physician services. In 1982, these two entities merged to form the modern-day BCBS Association.

BCBS plans are known for their extensive provider networks, which typically include a wide range of hospitals, doctors, and other healthcare professionals. The specific benefits, costs, and coverage options vary by plan and region but generally offer comprehensive medical services, including preventive care, specialist visits, hospital stays, and prescription medications.

BCBS also participates in various federal and state health programs, such as Medicare Advantage plans, Medicaid managed care, and the Children's Health Insurance Program (CHIP). Additionally, BCBS offers international insurance options for individuals living or traveling abroad.

It is essential to research and compare different BCBS plans and offerings in your area to determine which one best suits your specific healthcare needs and budget.

Cost-benefit analysis (CBA) is a systematic process used to compare the costs and benefits of different options to determine which one provides the greatest net benefit. In a medical context, CBA can be used to evaluate the value of medical interventions, treatments, or policies by estimating and monetizing all the relevant costs and benefits associated with each option.

The costs included in a CBA may include direct costs such as the cost of the intervention or treatment itself, as well as indirect costs such as lost productivity or time away from work. Benefits may include improved health outcomes, reduced morbidity or mortality, and increased quality of life.

Once all the relevant costs and benefits have been identified and quantified, they are typically expressed in monetary terms to allow for a direct comparison. The option with the highest net benefit (i.e., the difference between total benefits and total costs) is considered the most cost-effective.

It's important to note that CBA has some limitations and can be subject to various biases and assumptions, so it should be used in conjunction with other evaluation methods to ensure a comprehensive understanding of the value of medical interventions or policies.

The term "European Continental Ancestry Group" is a medical/ethnic classification that refers to individuals who trace their genetic ancestry to the continent of Europe. This group includes people from various ethnic backgrounds and nationalities, such as Northern, Southern, Eastern, and Western European descent. It is often used in research and medical settings for population studies or to identify genetic patterns and predispositions to certain diseases that may be more common in specific ancestral groups. However, it's important to note that this classification can oversimplify the complex genetic diversity within and between populations, and should be used with caution.

I'm sorry for any confusion, but the term "Private Sector" is not a medical definition. It is an economic and sociopolitical term that refers to businesses and organizations which are not owned or controlled by the government. They can be privately owned and operated for profit, such as corporations, partnerships, and sole proprietorships, or they can be non-profit organizations, such as charities and advocacy groups. The private sector is distinct from the "Public Sector," which includes entities that are owned and controlled by the government, like public schools, hospitals, and other services provided by the state.

'Government Financing' in the context of healthcare refers to the role of government in funding healthcare services, programs, and infrastructure. This can be achieved through various mechanisms such as:

1. Direct provision of healthcare services: The government operates and funds its own hospitals, clinics, and other healthcare facilities, where it employs healthcare professionals to deliver care.
2. Public insurance programs: The government establishes and manages health insurance programs, like Medicare and Medicaid in the United States, which provide coverage for specific populations and reimburse healthcare providers for services delivered to enrollees.
3. Tax subsidies and incentives: Governments may offer tax breaks or other financial incentives to encourage private investments in healthcare infrastructure, research, and development.
4. Grants and loans: Government agencies can provide funding to healthcare organizations, researchers, and educational institutions in the form of grants and loans for specific projects, programs, or initiatives.
5. Public-private partnerships (PPPs): Governments collaborate with private entities to jointly fund and manage healthcare services, facilities, or infrastructure projects.

Government financing plays a significant role in shaping healthcare systems and ensuring access to care for vulnerable populations. The extent of government involvement in financing varies across countries, depending on their political, economic, and social contexts.

I'm not aware of any medical definition for the term "Florida." It is primarily used to refer to a state in the United States located in the southeastern region. If you have any specific medical context in which this term was used, please let me know and I will do my best to provide a relevant answer.

Veterans hospitals, also known as Veterans Administration (VA) hospitals, are healthcare facilities provided by the US Department of Veterans Affairs. These hospitals offer comprehensive medical care, including inpatient and outpatient services, to eligible veterans. The services offered include surgery, mental health counseling, rehabilitation, long-term care, and other specialized treatments. The mission of veterans hospitals is to provide high-quality healthcare to those who have served in the US military.

I'm sorry for any confusion, but the "Tax Equity and Fiscal Responsibility Act" is not a medical term or concept. It is a legislative act in the field of federal budget policy in the United States. Specifically, the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 was a significant piece of legislation aimed at reducing the federal budget deficit through a combination of spending cuts and tax increases.

The TEFRA had wide-ranging impacts on various sectors, including healthcare, but it is not a medical term or definition in and of itself. If you have any questions related to medical terminology or concepts, I would be happy to try to help answer those for you!

Look up Medicare or medicare in Wiktionary, the free dictionary. Medicare may refer to several publicly funded health insurance ... Medicare All pages with titles containing Medicare This disambiguation page lists articles associated with the title Medicare. ... a single plastic identity card used to identify individuals both inside and outside of the Medicare scheme Medicare (Canada), ... Australian private health insurance provider Medicaid Medicare Resources, Hong Kong Medicare Rights Center, United States All ...
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"Medicare Fraud Center - Report Medicare Fraud Here". "Who can become a Medicare fraud whistleblower?". "Alleged misconduct by ... "Medicare Fraud Reporting Center - Report Medicare Fraud Here - What is Medicare Fraud?". Medicarefraudcenter.org. Retrieved ... Recent Medicare Fraud Scams and Busts Hank Pomeranz, Retrieved May 23, 2013. U.S. charges 89 people in Medicare fraud schemes U ... Stop Medicare Fraud site by US Government Fraud Overview at Medicare.gov site FBI.gov (Webarchive template wayback links, CS1 ...
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... (Chinese: 香港醫療關懷) is a Hong Kong-based non-government organisation which is dedicated to serve the needy in ... Medicare Resources Ltd aims to show its devotion to the underprivileged (even though most of them are not Christians) under the ... Medicare Resources Ltd Evangelical Free Church of America (EngvarB from May 2016, Use dmy dates from May 2016, Articles with a ... Directors of Medicare Resources Ltd has close relationship with the officials and they benefited by constant visits to Hubei. ...
... (Medicare Part C, MA) is a capitated program for providing Medicare benefits in the United States. Under ... "Medicare & You: 2022" (PDF). Centers for Medicare and Medicaid Services. Retrieved September 8, 2022. "What is Medicare Part C ... Original Medicare and Medicare Advantage pay healthcare providers differently. Original Medicare typically reimburses ... As of 2023, about 50% of Medicare beneficiaries were members of Medicare Advantage plans. Nearly all Medicare beneficiaries ...
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"History". Friends of Medicare. "Friends of Medicare Introduction". Alberta Labour History. "Friends of Medicare campaign to ... launched Friends of Medicare in 2007 a campaign to protect and improve public health care in B.C. In 2019, Friends of Medicare ... The Friends of Medicare fought against extra billing in the 1980s and against the introduction of private, for-profit health ... Friends of Medicare applauded the new guide, but said the best way to ensure affordability is to eventually have dental ...
"About Medicare Rights Center". Medicare Rights Center. Retrieved 2019-04-02. McReynolds, J.E. (1992-04-08). "Medicare ... The Medicare Rights Center is a nonprofit organization founded in June 1989 as the Medicare Beneficiaries Defense Fund (MBDF) ... The Medicare Rights Center also maintains an online reference and coursework tool called Medicare Interactive (MI). " ... "Medicare Interactive". Medicare Interactive. Retrieved 2019-04-02. Franklin, Mary Beth (12 April 2017). "Courses available to ...
The Better Medicare Alliance (BMA) is an American 501(c)(4) advocacy and research group that supports Medicare Advantage, a ... "Our Allies". Better Medicare Alliance. Herman, Bob (April 21, 2015). "Allyson Schwartz named CEO of Medicare Advantage lobbying ... "About". Better Medicare Alliance. Archived from the original on August 11, 2015. Retrieved August 5, 2015. Alonso-Zaldivar, ... In early 2015, the group strongly opposed the rate decrease proposed by the Centers for Medicare and Medicaid Services (CMS) ...
Medicare at cms.gov Medicare.gov-the official U.S. government site for Medicare Medicare Primer Congressional Research Service ... Medicare (Canada) Medicare Access and CHIP Reauthorization Act of 2015 Medicare for All Act Medicare Prompt Pay Correction Act ... Centers for Medicare & Medicaid Services. "Medicare 2017 costs at a glance". Medicare, U.S. Centers for Medicare & Medicaid ... Medicare cards Medicare has four parts: Part A, B, C, & D. In April 2018, CMS began mailing out new Medicare cards with new ID ...
Medicare Payment Advisory Commission. 2020. p. 155. Damico, Anthony (2020-10-29). "Medicare Part D: A First Look at Medicare ... Official Medicare publications at Medicare.gov, includes official publications about the Part D benefit. Medicare & You ... Medicare.gov, the official website for people with Medicare. Prescription Drug Coverage homepage at Medicare.gov, a central ... Medicare Payment Advisory Commission. 2020. p. 168. Report to the Congress: Medicare Payment Policy (PDF). Medicare Payment ...
"Senior Medicare Patrols Help to Stop Medicare Fraud - ExpertMedicare.com". Retrieved 2016-08-09. "Senior Medicare Patrol ... Medicare fraud Murrin, Suzanne. "Memorandum Report: 2019 Performance Data for the Senior Medicare Patrol Projects" (PDF). U.S. ... The Senior Medicare Patrols (SMP) are a group of volunteer organizations funded by the United States Department of Health and ... From the program's start in 1997 through December 2019, SMP projects and staff have recovered about $129 million in Medicare ...
Medicare cards may be used to show a relationship when parents have different surnames to their children. Individual Medicare ... The card must be produced or the Medicare number provided if the Medicare rebate is paid directly to the doctor under the bulk ... Legally, the card need not be produced and a Medicare number is sufficient. Since 2002, a Medicare card has been required to be ... The primary purpose of the Medicare card is to prove eligibility when seeking Australian Medicare-subsidised care from a ...
Medicare is the primary payer for most services, but Medicaid covers benefits not offered by Medicare. Medicare coverage for ... For Medicare benefits, beneficiaries may opt to enroll in Medicare's traditional fee-for-service (FFS) program or in a private ... Medicare & You handbook Order newest (printed) or download newest(PDF) version from Medicare website. Dual Eligible FAQ for ... Dual-eligible beneficiaries (Medicare dual eligibles or "duals") refers to those qualifying for both Medicare and Medicaid ...
v. Mingyuan Medicare Development et al" (PDF). The Supreme Court of Bermuda. 22 March 2016. Retrieved 1 October 2017. 銘源財務文件失竊 ... Mingyuan Medicare Development Co., Ltd. formerly known as Shanghai Ming Yuan Holdings Limited and Sing Tao Holdings Limited, is ... Mingyuan Medicare Development failed to publish 2014, 2015 and 2016 annual reports. The company was suspended from trading ... As of 31 December 2013 "2013 Annual Report" (PDF). Mingyuan Medicare Development. 30 April 2014. Retrieved 30 September 2017 - ...
The Medicare Payment Advisory Commission (MedPAC) is an independent, non-partisan legislative branch agency headquartered in ... Its primary role is to advise the US Congress on issues affecting the administration of the Medicare program. Specifically the ... MedPAC is also relied on by Medicare administrators and policy makers to evaluate beneficiaries' access to care, quality of ... MedPAC produces two major reports to the United States Congress each year that contain recommendations to improve Medicare. ...
The Medicare for All Caucus is a congressional caucus in the United States House of Representatives, consisting of members that ... Cori Bush (MO-1), who, as of January 2021, does favor Medicare for All. New York Carolyn Maloney (NY-12) lost redistricting ... "Congressional Medicare for All Caucus - Summary from LegiStorm". legistorm.com. Retrieved 2023-01-20. Resnick, Gideon (July 19 ... Ayanna Pressley (MA-7), who, as of September 2018, does favor Medicare-for All. Michigan Andy Levin (MI-9) lost redistricting ...
The Medicare for All Act (abbreviated M4A), also known as the Expanded and Improved Medicare for All Act or United States ... "House Reps Introduce Medicare-for-All Bill" Becker's Hospital Review, Feb. 14, 2013 "Medicare for All bill loses its special ... Pramila Jayapal's Medicare for All Act of 2019, introduced in the House is broadly similar but more detailed than the original ... "H.R.1384 - Medicare for All Act of 2019". U.S. Congress. Retrieved November 3, 2019. Krugman, Paul (June 13, 2005). "One Nation ...
"HEAT Task Force". STOP Medicare Fraud. U.S. Department of Health & Human Services. Retrieved November 28, 2013. "Medicare Fraud ... The Medicare Fraud Strike Force is a multi-agency team of United States federal, state, and local investigators who combat ... The scam was estimated to have cost Medicare over $1.2 billion. Twenty-four individuals were arrested in six states in ... "Feds break up $1.2 billion Medicare scam that peddled unneeded braces to seniors". CBS News via Associated Press. April 9, 2019 ...
Healthcare in Canada Two-tier healthcare "Canadian Doctors for Medicare". Canadian Doctors for Medicare. Retrieved 2023-04-12. ... Canadian Doctors for Medicare is a Canadian non-profit advocacy organization that was founded in Toronto in 2006. The ... Canadian Doctors for Medicare is based in Toronto, Ontario. The organization's first director was Danielle Martin, as of 2023, ... Duffin, Jacalyn (20 February 2018). "Doctors as Stewards of medicare, or not: CAMSI, MRG, CDM, DRHC and the thin alphabet soup ...
The Medicare Sustainable Growth Rate (SGR) was a method used by the Centers for Medicare and Medicaid Services (CMS) in the ... Medicare physician payment reform "Obama signs 6-month fix for medicare reimbursements to doctors". Kaiser Health News. June 25 ... That bill was the Protecting Access to Medicare Act of 2014 (H.R. 4302; 113th Congress). The table on the left is a table of ... The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) changed the calculation from fiscal year (FY) ...
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human ... Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people ... "CNN.com - Medicare agency renamed as prelude to reforms - June 14, 2001". www.cnn.com. Retrieved 2021-10-05. Ellis, Blake (2013 ... In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most. In ...
The Medicare Physician Group Practice (PGP) demonstration was Medicare's first physician pay-for-performance (P4P) initiative. ... Section 412 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 established the Medicare ... Centers for Medicare & Medicaid Services, Department of Health & Human Services, July 2011 Medicare Physician Payment: Care ... Centers for Medicare & Medicaid Services, Department of Health & Human Services, July 2011. Medicare Physician Group Practice ...
However, the Medicare Modernization Act of 2003 (MMA) required that prompt pay discounts be included in the calculation of ASP ... The bill is a step forward in addressing problems with Medicare reimbursement for cancer drugs. Excluding distributor prompt ... Their inclusion artificially reduces Medicare reimbursement rates by approximately 2%. Currently the prompt pay discounts ... Medicare and Medicaid (United States), All stub articles, United States federal legislation stubs, Medical treatment stubs). ...
... the official website of the Centers for Medicare and Medicaid Services Medicare at cms.gov Medicare.gov - the official website ... The Medicare Part D coverage gap (informally known as the Medicare donut hole) was a period of consumer payments for ... "2019 Medicare Part D Outlook". q1medicare.com. Retrieved March 18, 2019. "The Medicare Part D Prescription Drug Benefit". The ... Centers for Medicare and Medicaid Services (January 2015). "Closing the Coverage Gap-Medicare Prescription Drugs Are Becoming ...
clerk.house.gov/Votes/200723 v t e (Medicare and Medicaid (United States), United States proposed federal health legislation, ... In January 2007, the 110th United States House of Representatives approved H.R. 4, the Medicare Prescription Drug Price ... a provision that was part of the GOP-sponsored 2003 measure called the Medicare Prescription Drug, Improvement, and ... to negotiate with drug companies for lower prices for the 23 million senior citizens who have signed up for Medicare's ...
Allocate $300 million per year in Medicare funding to revise the Medicare payment system. Those payments would be based on ... of cancer patients who are beneficiaries of the Medicare program. This legislation for the Medicare Quality Cancer Care ... Establish a national Medicare demonstration project implemented by the Centers for Medicare & Medicaid Services (CMS) and is ... By the Medicare payment system, H.R. 2872 calls for national reporting of key metrics of evidence-based care, and also refines ...
"Home , Center for Medicare & Medicaid Innovation". innovation.cms.gov. Retrieved 2017-12-19. "Centers for Medicare and Medicaid ... Model and the Medicare Diabetes Prevention Program, and Medicare Prior Authorization Model for Repetitive Scheduled Non- ... The Center for Medicare and Medicaid Innovation (CMMI; also known as the CMS Innovation Center) is an organization of the ... Meredith B. Rosenthal (May 2011). "Hard choices - Alternatives for reining in Medicare and Medicaid spending". The New England ...
Medicare.gov - the official website for people with Medicare Medicare Modernization Act at Medicare.gov Prescription Drug ... Medicare Catastrophic Coverage Act of 1988, previous expansion, repealed 1989 Medicare dual eligible Medicare Part D Medicare ... including Medicare Advantage Plans Medicare Personal Plan Finder at Medicare.gov - more detailed information about Medicare ... as well as Medicare Advantage plans Official Medicare publications at Medicare.gov - includes official publications about ...
A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. ... These requirements dont apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, ...
Medicare at a Glance *. Medicare pays physicians about 80% of the "reasonable charge" for covered services. At the same time, ... Some Medicare Advantage plans do.. Medicare doesnt cover eye health (except for eye exams for diabetes patients), which is an ... The Medicare fee schedule is released each year. Physicians who accept Medicare can choose to be a "participating provider" by ... The Problem With Medicare Billing Because claims are processed by Medicare administrative contractors, it can take about a ...
Prevalence of Diagnosed Heart Disease Among Medicare Beneficiaries ... Geographic Patterns: Prevalence of diagnosed heart disease for 2020 for all Medicare Beneficiaries by County. The map shows ...
... medicare - Featured Topics from the National Center for Health Statistics ... Tags medicaid, medicare, public-use data, rdc, research data center, social security ... Tags CMS, confidentiality, medicare, Office of Analysis and Epidemiology, record linkage, SSA ...
Cost to Medicare of influenza vaccine delivery and savings to Medicare, based on severe and mild influenza seasons* -- Medicare ... Because some Medicare beneficiaries received influenza vaccines from sources not reimbursed by Medicare, annual surveys were ... an influenza vaccine benefit would generate savings for Medicare. Estimated net costs per year of life gained by a Medicare ... Cost To Medicare Of Influenza Vaccine Delivery And Savings. SUMMARY. Pneumonia and influenza (P&I) are the sixth leading cause ...
Centers for Medicare and Medicaid Services. In April 2020, CMS recommended that all nonessential planned surgeries and ... Guideline] Centers for Medicare & Medicaid Services (CMS) recommendations: re-opening facilities to provide non-emergent non- ... a recent history and physical examination within 30 days per Centers for Medicare and Medicaid Services (CMS) requirement is ... Centers for Medicare and Medicaid Services. Available at https://www.cms.gov/files/document/covid-elective-surgery- ...
... the new Medicare prescription-drug program, Medicare Part D, went into effect this week. What do you think? ... Criticized as needlessly confusing, the new Medicare prescription-drug program, Medicare Part D, went into effect this week. ... The new Medicare plan is far too difficult to make sense of, which is why I have chosen to die earlier than I had initially ...
About Medicare Nondiscrimination / Accessibility Privacy Policy Privacy Setting. Linking Policy Using this site Plain Writing ... Lower costs for Medicare-covered insulin The cost of a one-month supply of each Part B- and Part D-covered insulin is capped at ... A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services. 7500 Security ... Starting January 1, 2024, people with limited resources can qualify for even more savings on Medicare drug costs (Part D). Find ...
Doctors all over America are concerned that the Medicare reality will be changing rapidly for the worse once ObamaCare kicks in ... Medicare Advantage is a popular program among seniors that already allows them to turn traditional Medicare into private ... Without more privatization of Medicare, I am worried that the time will be coming soon when I simply wont be able to afford to ... I have long gotten used to the fact that Medicare pays me less than private insurance does, and that I write more prescriptions ...
Learn about codes; who is covered; frequency; and what the Medicare patient pays. ... This educational tool helps you properly provide and bill Medicare preventive services. The term "patient" refers to a Medicare ... Medicare Preventive Services Skip to the main content *. Alcohol Misuse Screening & Counseling ... The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & ...
This is the traditional fee-for-service plan provided by Medicare. Or, you can choose Medicare Advantage (also known as Part C ... Do you know that there are different ways you can get your Medicare health and prescription drug coverage? You can choose ... Q: What is Medicare Advantage?. A: Medicare Advantage, or Medicare Part C, is a privately run alternative to original Medicare ... Q: What is Original Medicare ?. A: Original Medicare, also known as traditional Medicare, includes Part A and Part B. It allows ...
Medicare does not generally cover Viagra, but it might cover the generic version if a doctor prescribes it to treat a medically ... Similar to original Medicare, Medicare Part D, which covers medications, sees the treatment of ED as lifestyle-enhancing rather ... To help with uninsured healthcare costs, some people with original Medicare buy a Medigap plan, which is a Medicare supplement ... https://www.medicare.org/articles/does-medicare-cover-viagra/. *. Medicare Advantage plans [Fact sheet]. (n.d.).. https://www. ...
Learn about the different parts of Medicare - A, B, C, and D - as well as Medicare Advantage. ... Get details on signing up for Medicare, what to do if you miss a deadline, and how to change or switch plans. ... Find out how to get help signing up for Medicare and learn ways to make the most of it once youre enrolled. ... Retired podiatrist Sam Ruggiero, DPM, is no stranger to helping patients navigate the alphabet soup of Medicare. ...
Australia portal Health care in Australia Medicare card (Australia) Medicare (Canada) Medicare (United States) National Health ... where Medicare will pay the patient at a later date), online, through the Medicare mobile apps, or at joint Medicare-Centrelink ... Under the original Medicare safety net, once an annual threshold in gap costs has been reached, the Medicare rebate for out-of- ... Medicare issues each person entitled to receive benefits under the scheme with a Medicare card which has a number that must be ...
... (also called Medigap), is private health insurance that is ... Medicare supplement insurance policies cover some of the out-of-pocket expenses not covered by Medicare. ... Types of Insurance AutomobileHomeowner/ResidentialLife And AnnuityLong-Term CareMedicare SupplementPetTNC RidesharingWorkers ... If you do not find the information you need or you are experiencing a problem with a Medicare supplement insurance policy, we ...
Medicare Part B and Part D may provide coverage for insulin, insulin pumps, and other diabetes supplies and preventive services ... Original Medicare, Medicare Advantage (Part C), Medicare Part D, and Medigap may provide coverage for diabetes supplies and ... Medicare Part B does not cover insulin unless a person is medically required to use an insulin pump. In this case, Medicare ... Medicare will generally cover FreeStyle Libre for qualifying Medicare enrollees as a means to help manage type 1 or type 2 ...
... www.kff.org/medicare/issue-brief/medicare-advantage-in-2008/ class=see-more light-beige no-float inline-readmore,More,/a,,/p ... more than one in five of the nations 44 million people on Medicare as of April 2008. That represents an increase of more than ... 800,000 beneficiaries in just four months, continuing a period of unprecedented growth for private plans in Medicare since 2003 ... Medicare Advantage plans enrolled a record 9.8 million beneficiaries, ...
Medicare Advantage or MA Plans are another way for beneficiaries to get Medicare Part A and Part B coverage delivered through ... The Centers for Medicare & Medicaid Services (CMS) April 5 finalized its Policy and Technical Changes to the Medicare Advantage ... Medicare Advantage, Medicaid managed care plans to draw scrutiny from HHS watchdog ... A bipartisan group of 233 representatives and 61 senators called on the Centers for Medicare… ...
AARPs Medicare Question and Answer Tool is a starting point to guide you through how Medicare works with other health coverage ... Do you have coverage from another source in addition to Medicare? ... Social Security & Medicare * Medicare Resource Center Leaving AARP.org Website. Close. You are leaving AARP.org and going to ... En español , Do you have coverage from another source in addition to Medicare? AARPs Medicare Question and Answer Tool is a ...
The penalties for late enrollment could follow you around for as long as youre enrolled in Medicare. ... Otherwise, if you're an existing member of Medicare, remember that you have until Dec. 7 to select an original Medicare ... 7 you'll miss out on your opportunity to purchase a Medicare Advantage plan in 2017. Medicare Advantage plans have grown ... 14 each year that allows eligible people to unenroll from a Medicare Advantage plan and enroll in an original Medicare plan ...
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would create new exceptions to the so-called ... Cite this: Medicare Proposes Overhaul to Kickback Laws - Medscape - Oct 09, 2019. ... now can stand in the way of what CMS describes as value-based arrangements at a time of increasing emphasis on pegged Medicare ... intended to stop physicians from profiting at the expense of patients at a time when there was little challenge to Medicares ...
... employers should be prepared for questions on how Medicare overlaps with the workplace health plan and affects the use of ... employers should be prepared for questions on how Medicare overlaps with the workplace health plan and affects the use of ... employers should be prepared for questions on how Medicare overlaps with the workplace health plan and affects the use of ... Part C refers to Medicare Advantage plans offered by Medicare-approved insurance companies in lieu of standard Medicare. ...
Learn how we support the goal of aligning Medicare payments and value of patients care. ... ACP advocates to make the Medicare system work for internists and their patients. ... Improving Medicare. Background. The Medicare program is critical to ensuring that the elderly and others in the United States ... PolicyPromoting Transparency and Alignment in Medicare Advantage 10/2017. *PolicyReforming Medicare in the Age of Deficit ...
Indiana SHIP YouTube. Medicare.gov. Medicare Planfinder Tool. Centers for Medicare & Medicaid Services. MyMedicare.gov. Social Security Administration. Fort Wayne Area SHIP. Senior Resource Guide for Southern Indiana. Social Security remains committed to providing uninterrupted benefits and vital services the public relies on, especially during the current corona virus pandemic. They provide local office phone numbers conveniently online with they Social Security Office Locator. Or take advantage of their secure and convenient online services.. During the COVID-19 federal public health emergency, due to federal requirements, Indiana Medicaid members were able to keep their coverage without interruption. The most recent federal spending bill ended Medicaid coverage protections, which means Indiana Medicaid will return to normal operations. Eligibility redetermination actions will begin in April 2023, with a 12-month plan to return to normal operations. Many of these redeterminations are ...
What is Medicare Part A?. Medicare Part A helps cover your inpatient care in hospitals, critical access hospitals, and skilled ... Eligibility: To learn if you are eligible for Medicare, use the Medicare Eligibility Tool. ... This is because they or a spouse paid Medicare taxes while they were working. If you (or your spouse) didnt pay Medicare taxes ... If you arent sure if you have Part A, look on your red, white, and blue Medicare card. If you have Part A, "Hospital (Part A ...
Private insurers allow doctors to charge more than Medicare does. ... How does Medicare get away with paying less? "Medicare doesnt ... Why, then, is Medicare considered bloated? Its more about use than prices, with the government under more pressure to pay for ... Overall, Medicares allowed charges are roughly 80% of the charges allowed by private insurers - about the same as they have ... Medicare has the bad rap of being a big, bloated government program, but its not because its overpaying doctors. ...
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 , Phone 202-347-5270 www.kff.org , Email Alerts: kff.org/email , facebook.com/KFF , twitter.com/kff. The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California. ...
Medicare does cover hernia surgery if your doctor considers it medically necessary. Hernia repair surgery is the primary ... Medicare Part C. Medicare Part C is also known as Medicare Advantage. It covers everything that original Medicare does and ... Depending on where you have your surgery, you might be covered under Medicare Part A, Medicare Part B, or your Medicare ... Medicare costs at a glance. (2020).. https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance. ...
Forbes Health provides data-backed guides to help you find the Medicare coverage you need most. Explore our detailed articles ... Helping You Find The Medicare Coverage You Need Most. Medical experts and passionate journalists. Thorough research and solid ... Medicare Plans By State Medicare Advantage By State Medicare Advantage In Florida Medicare Advantage In New York Medicare ... What Is Medicare Supplement? Navigating Medicare Advantage Medicare Advantage vs. Medicare Supplement Medicare vs. Medicaid ...
  • In fact, about 65% of doctors won't accept new Medicare patients, down from 71% 5 years ago, according to the Medscape Physician Compensation Report 2023 . (medscape.com)
  • In an Aug. 28 letter to House sponsors, the AHA voiced support for the GOLD Card Act of 2023 (H.R. 4968) that would exempt qualifying providers from prior authorization requirements under Medicare Advantage plans. (aha.org)
  • Some Medicare Costs Are Heading Higher in 2023, While Others Are Going Down. (nbcsandiego.com)
  • More New Yorkers are now eligible for the Medicare Savings Program in 2023. (medicareinteractive.org)
  • Prevalence of diagnosed heart disease for 2020 for all Medicare Beneficiaries by County. (cdc.gov)
  • In 1988, the Health Care Financing Administration (HCFA) and CDC began a congressionally mandated 4-year demonstration project to evaluate the cost-effectiveness to Medicare of providing influenza vaccine to Medicare beneficiaries. (cdc.gov)
  • Before the 1990-91 and 1991-92 influenza seasons, the HCFA sent letters to all Medicare beneficiaries living in the intervention areas urging them to be vaccinated. (cdc.gov)
  • In addition, intervention sites undertook varied activities directed to both providers and patients to promote and distribute vaccine to Medicare beneficiaries (4). (cdc.gov)
  • Because some Medicare beneficiaries received influenza vaccines from sources not reimbursed by Medicare, annual surveys were conducted to accurately estimate vaccine coverage in each intervention and comparison site. (cdc.gov)
  • Original Medicare, also known as traditional Medicare, includes Part A and Part B. It allows beneficiaries to go to any doctor or hospital that accepts Medicare, anywhere in the United States. (aarp.org)
  • In 2017, most Medicare beneficiaries can choose from a variety of plans from at least six insurance companies. (aarp.org)
  • Medicare Advantage plans enrolled a record 9.8 million beneficiaries, more than one in five of the nation's 44 million people on Medicare as of April 2008. (kff.org)
  • That represents an increase of more than 800,000 beneficiaries in just four months, continuing a period of unprecedented growth for private plans in Medicare since 2003. (kff.org)
  • This issue brief, prepared for the Kaiser Family Foundation by Marsha Gold of Mathematica Policy Research, Inc., analyzes recent developments in the Medicare Advantage marketplace, including plan choices available to beneficiaries and enrollment trends by plan type and geography. (kff.org)
  • Medicare Advantage or MA Plans are another way for beneficiaries to get Medicare Part A and Part B coverage delivered through private health insurance companies. (aha.org)
  • It's also the time of the year when the roughly 56 million eligible Medicare beneficiaries, most of whom are ages 65 and up, have the option to enroll in the various components of Medicare. (foxbusiness.com)
  • There's also the traditional Oct. 15 through Dec. 7 enrollment period we're in now when existing beneficiaries can change prescription drug plans and switch between original Medicare and an alternative plan offered by private insurance companies known as Medicare Advantage (also known as Part C). (foxbusiness.com)
  • Three Medicare beneficiaries with a serious eye disease are claiming the Bush administration is violating the law by not allowing them to appeal its decision to deny coverage for a drug that could prevent them from going blind. (elderlawanswers.com)
  • Medicare officials have issued guidelines allowing homebound beneficiaries to leave their homes for special occasions--such as family reunions, graduations or funerals--without losing their home health care benefits. (elderlawanswers.com)
  • These programmatic changes will give states the ability to make meaningful changes in the Medicare and Medicaid programs that will not only improve health care for beneficiaries but actually save money at the state and federal levels. (nga.org)
  • Since 1988, the federal government has increasingly passed on to the states the responsibility to cover the cost-sharing responsibilities of many low-income Medicare beneficiaries (e.g., the Qualified Medicare Beneficiary Program, the Specified Low-Income Medicare Beneficiary Program, and the new groups of beneficiaries created by the BBA, the Qualifying Individuals). (nga.org)
  • Care providers are discovering newly eligible Medicare beneficiaries who haven't yet received their card, while existing beneficiaries have misplaced theirs. (experian.com)
  • Leavitt said he believes the additional 2 million enrollees over the past month is a signal that Medicare beneficiaries see value in the program. (foxnews.com)
  • How do I enroll in Original Medicare? (aarp.org)
  • It's easy if you receive Social Security retirement benefits: The Social Security Administration will automatically enroll you in Medicare when you turn 65. (aarp.org)
  • If you are under 65 and get disability benefits, the Social Security Administration will enroll you in Medicare after you have received benefits for 24 months. (aarp.org)
  • Is enrollment in a Medicare Advantage plan automatic or do I need to enroll directly with the plan? (aarp.org)
  • Medicare doesn't automatically enroll you in a Medicare Advantage plan - you need to choose a plan and sign up directly. (aarp.org)
  • If your Medicare Advantage plan is ending at the end of the year, you can join another Medicare Advantage plan or enroll in original Medicare. (aarp.org)
  • Can I keep it or will Medicare make me drop it and enroll in a Part D drug plan? (aarp.org)
  • The VA does not require you to enroll in Medicare but suggests that there are strong reasons you should. (aarp.org)
  • For starters, if you fail to enroll by Dec. 7 you'll miss out on your opportunity to purchase a Medicare Advantage plan in 2017. (foxbusiness.com)
  • Though a special enrollment period exists between Jan. 1 and Feb. 14 each year that allows eligible people to unenroll from a Medicare Advantage plan and enroll in an original Medicare plan without any penalties, this is a one-way street. (foxbusiness.com)
  • When should I enroll in Medicare? (shrm.org)
  • Generally, individuals can enroll in Medicare within a seven-month window around the time they turn age 65. (shrm.org)
  • This is why many employees who continue working will enroll in Part A but not in the parts of Medicare that charge monthly premiums. (shrm.org)
  • I was told I must enroll in Medicare Part A to receive retirement benefits. (newsday.com)
  • People 65 and older must enroll in Medicare Part A (hospital coverage) to receive Social Security retirement benefits. (newsday.com)
  • HSA withdrawals after you enroll in Medicare are tax-free if you use them to pay for qualified medical expenses. (newsday.com)
  • You don't need to enroll in Medicare Part B (physician services) to collect Social Security. (newsday.com)
  • Previously, they could enroll in only original Medicare and Medicare Part D. (healthline.com)
  • You do not need to be an AARP member to enroll in a Medicare Advantage or Prescription Drug Plan. (uhc.com)
  • These requirements don't apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. (cms.gov)
  • A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services. (medicare.gov)
  • The Health and Human Services Office of Inspector General Aug. 28 released a strategic plan to align its audits, evaluations, investigations and enforcement of managed care plans in Medicare Advantage and Medicaid. (aha.org)
  • The Centers for Medicare & Medicaid Services (CMS) April 5 finalized its Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program for contract year (CY) 2024. (aha.org)
  • The Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would create new exceptions to the so-called Stark law, which dates to 1989. (medscape.com)
  • Both the Social Security Administration and the U.S. Centers for Medicare & Medicaid Services (CMS) can provide such information as how income from employment may impact Medicare premiums and specific actions Medicare-eligible employees may take when they reach age 65. (shrm.org)
  • In recent years the program has undergone changes with a shift toward the use of value-based payments, the start of the Quality Payment Program, and an increase in testing different practice and payment models through the Centers for Medicare and Medicaid Innovation and other avenues. (acponline.org)
  • CNNMoney analyzed the "allowed charges" for five common procedures, using data provided the Centers for Medicare and Medicaid Services and Truven Health Analytics, a research firm. (cnn.com)
  • When Republicans howled in protests during the State of the Union over President Biden's suggestion that the GOP wanted to slash Medicare and Medicaid, it showcased a stunning turnaround for the Republican Party that built a brand on doing just that. (nbcsandiego.com)
  • On Thursday, June 14, the Bush administration announced that it would rename the Health Care Financing Administration (HCFA) the Centers for Medicare and Medicaid Services (CMS). (elderlawanswers.com)
  • A report released from the Centers for Medicare and Medicaid Services says a patient died after a nurse at the Vanderbilt University Medical Center in Nashville selected the wrong medication to give them, putting at risk the hospital's ability to receive Medicare payments. (newschannel5.com)
  • An investigation from the Centers for Medicare and Medicaid Services found the error occurred through the nurse's improper use of an automatic medication dispensing machine, when the nurse mistakenly dispensed the wrong medication. (newschannel5.com)
  • The error had originally put the hospital's Medicare reimbursement status in jeopardy, but the Centers for Medicare and Medicaid Services announced Thursday that it had accepted a corrective plan submitted by the hospital, which allows the reimbursements to continue. (newschannel5.com)
  • We will continue to work closely with representatives of Tennessee Department of Health and Centers for Medicare and Medicaid Services to assure that any remaining concerns are fully resolved within the specified time frame," said John Howser, Chief Communications Officer, VUMC. (newschannel5.com)
  • The primary concern for states in the Medicare reform debate is the issue of dual eligibility - the six million individuals eligible for both Medicare and Medicaid. (nga.org)
  • Beyond these specific changes, Governors ask that you remember the interrelation of the two programs and consider the potential implications for Medicaid before proposing changes to Medicare. (nga.org)
  • The lack of coordination between the Medicare and Medicaid programs contributes to the fragmentation of acute and long-term care. (nga.org)
  • Currently, it is impossible for Medicaid to participate in acute care decisions when Medicare is the primary payer. (nga.org)
  • Ultimately, poor clinical outcomes and service decisions that are reimbursement-driven lead to higher expenditures for both Medicare and Medicaid. (nga.org)
  • APIAHF submitted regulatory comments in response to the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) on the Medicare Advantage (MA) Program. (apiahf.org)
  • Health and Human Services Secretary Xavier Becerra on Monday announced that he is instructing the Centers for Medicare & Medicaid Services to reassess this year's standard premium, which jumped to $170.10 from $148.50 in 2021. (cnbc.com)
  • Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills. (cdc.gov)
  • The Centers for Medicare & Medicaid Services (CMS) has planned similar cuts to retinal detachment repair codes, with reimbursement for CPT 67108 (repair of retinal detachment with vitrectomy) reduced by 33.6%, CPT code 67110 (pneumoretinopexy) reduced by 19%, and CPT code 67107 (retinal detachment repair/scleral buckle) reduced by 16% for 2016. (medscape.com)
  • Centres for Medicare and Medicaid Services (CMS). (who.int)
  • If you have a Medicare Advantage plan, you cannot buy a Medicare Supplement Insurance or Medigap plan. (aarp.org)
  • To help with uninsured healthcare costs, some people with original Medicare buy a Medigap plan , which is a Medicare supplement insurance. (medicalnewstoday.com)
  • Medigap is Medicare supplement insurance. (healthline.com)
  • Oh, and Medicare A is so skimpy that it's preferable if you can afford it to buy a private Medigap policy too. (nakedcapitalism.com)
  • While these three doctors find Medicare lacking in its coverage of their specialty, and their reimbursements are too low, many physicians also find fault regarding Medicare billing, which can put their patients at risk. (medscape.com)
  • Do you know that there are different ways you can get your Medicare health and prescription drug coverage? (aarp.org)
  • You can also get Medicare prescription drug coverage to help cover some of the costs of your prescription drugs. (aarp.org)
  • There are different parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage) and Part D (prescription drug coverage). (aarp.org)
  • To get drug coverage under Original Medicare, you must choose and join a Medicare-approved Part D private drug plan. (aarp.org)
  • Do Medicare Advantage plans provide the same coverage as Original Medicare? (aarp.org)
  • You can change plans or join original Medicare once a year during the annual open enrollment period, from Oct. 15 through Dec. 7, and your new coverage will begin Jan. 1 of the following year. (aarp.org)
  • In this article, we look at Medicare coverage for insulin pumps and insulin. (medicalnewstoday.com)
  • We also discuss Medicare coverage for other diabetes-related supplies and services. (medicalnewstoday.com)
  • If a person has questions about the coverage of insulin, insulin pumps, or related supplies, they can call 1-800-MEDICARE. (medicalnewstoday.com)
  • Medicare Part B provides coverage for several types of diabetes-related services and equipment. (medicalnewstoday.com)
  • A person needs to get a written order from their doctor to get Medicare coverage. (medicalnewstoday.com)
  • Do you have coverage from another source in addition to Medicare? (aarp.org)
  • AARP's Medicare Question and Answer Tool is a starting point to guide you through how Medicare works with other health coverage. (aarp.org)
  • No, you can't delay Medicare enrollment until COBRA expires - not without facing a gap in coverage and late penalties. (aarp.org)
  • Medicare becomes your primary health insurance and TRICARE For Life becomes supplemental coverage that wraps around Medicare benefits. (aarp.org)
  • Instead of potentially enrolling in multiple plans with original Medicare (Part A, B, and D), Medicare Advantage plans are structured such that all coverage fits neatly under one umbrella, and can be purchased as such. (foxbusiness.com)
  • Part C also comes with the option of dental, hearing, and vision coverage, which isn't something that's covered, or can be purchased, under original Medicare. (foxbusiness.com)
  • These privately administered plans charge monthly premiums and provide coverage compatible with Medicare but with different out-of-pocket costs and rules. (shrm.org)
  • Medicare Part A has a deductible that you'll need to pay before coverage starts. (healthline.com)
  • You can get coverage for hernia surgery using multiple parts of Medicare. (healthline.com)
  • It covers everything that original Medicare does and often includes coverage for additional services, too. (healthline.com)
  • Medicare Part D. Medicare Part D is prescription drug coverage. (healthline.com)
  • What Is The Medicare Donut Hole Coverage Gap? (forbes.com)
  • Is The Alzheimer's Drug Leqembi Eligible For Medicare Coverage? (forbes.com)
  • In fact, to avoid a tax penalty, you should stop your HSA contributions six months before starting Social Security because Medicare Part A coverage is six months retroactive. (newsday.com)
  • Typically, employer-provided coverage becomes secondary insurance at that point -- which means it stops paying bills that would be covered by Medicare. (newsday.com)
  • These plans work in place of your original Medicare coverage. (healthline.com)
  • Many managed care plans offer coverage for services that original Medicare doesn't. (healthline.com)
  • Medicare care managed care plans are an optional coverage choice for people with Medicare. (healthline.com)
  • Managed care plans take the place of your original Medicare coverage. (healthline.com)
  • The Bush administration has decided to comply with federal law and authorize Medicare coverage for the treatment of Alzheimer's disease and other dementias. (elderlawanswers.com)
  • The reason that many look favorably upon Medicare is they have crap coverage now, say no insurance at all, a non-subsidized Obamacare plan (often meaning high premiums and high deductibles) or a not-very-good corporate plan (I know a big Pharma exec who reports that Obamacare will be an improvement on his company's insurance). (nakedcapitalism.com)
  • Medicare consists of a dizzying number of parts: Medicare A, which is hospital coverage. (nakedcapitalism.com)
  • Proponents like to say it's free if you've paid Medicare taxes for 40 quarters but it isn't, since you are pretty much obligated to sign up for Medicare Part B (doctors outside hospitals) and Part D (drugs) because the penalties for joining Medicare B after you have started with Medicare A are draconian, and not having drug coverage if you take any is generally not a hot idea. (nakedcapitalism.com)
  • Medicare provides essential healthcare coverage for eligible individuals in the United States. (benzinga.com)
  • In this post, we will provide you with a comprehensive overview of Medicare benefits, outlining the different parts of the program and the coverage they offer. (benzinga.com)
  • Some plans may also include additional benefits not covered by Medicare Part A and B, such as prescription drug coverage (Part D), dental, vision, and hearing services. (benzinga.com)
  • Medicare Part D provides coverage for prescription medications that you pick up at a retail pharmacy. (benzinga.com)
  • While technically not a "Part" of Medicare, Medicare Supplement plans provide important coverage to warrant talking about. (benzinga.com)
  • Understanding the various parts of Medicare and their associated benefits is crucial to accessing the healthcare coverage you need. (benzinga.com)
  • Seniors are more likely to have health insurance coverage than any other group, and, together with Social Security, Medicare has drastically reduced the number of seniors living in poverty. (nga.org)
  • Medicare Advantage is vital to addressing health disparities and expanding access to quality medical coverage and social benefits to AA and NH/PI seniors, who represent nearly 5 percent of all MA enrollees. (apiahf.org)
  • Medicare officials are expected this week to release a preliminary decision on coverage - i.e., whether it will cover Aduhelm at all or limit its use to certain patients under certain conditions. (cnbc.com)
  • While Medicare Part D provides prescription drug coverage, some medicines are administered in a doctor's office - as with Aduhelm, which is delivered intravenously - and therefore covered under Part B. (cnbc.com)
  • They came to Experian Health to find a more efficient way to check Medicare coverage. (experian.com)
  • We knew we could help because we already had Medicare coverage history through our historical repository. (experian.com)
  • As a test, we were given a control set of known Medicare patients without MBIs, and were charged with finding those patients' MBIs and Medicare coverage. (experian.com)
  • Coverage Discovery found 60% of the Medicare coverages with MBIs, plus additional coverages. (experian.com)
  • We can help you search for Medicare coverage and make sure your clients find their MBIs, easing pressure off your revenue cycle management teams during this extremely challenging time. (experian.com)
  • You can choose Original Medicare. (aarp.org)
  • Original Medicare provides many health care services and supplies, but it doesn't pay all your expenses. (aarp.org)
  • Does Original Medicare automatically include Part A, Part B and Part D? (aarp.org)
  • You get Part A and Part B of the Original Medicare plan when you're automatically signed up for Medicare. (aarp.org)
  • Medicare Advantage, or Medicare Part C, is a privately run alternative to original Medicare. (aarp.org)
  • Medicare Advantage plans are sold by Medicare-approved private insurance companies and must cover the same health care services as original Medicare (except hospice care). (aarp.org)
  • How are Medicare Advantage plans different from Original Medicare? (aarp.org)
  • The private plans operate differently from original Medicare in several ways. (aarp.org)
  • Does original Medicare cover Viagra? (medicalnewstoday.com)
  • Original Medicare includes Part A , which is inpatient hospital insurance, and Part B , which is medical insurance. (medicalnewstoday.com)
  • Original Medicare will not cover the brand name drug Viagra. (medicalnewstoday.com)
  • Advantage plans are an alternative to original Medicare. (medicalnewstoday.com)
  • Similar to original Medicare, Medicare Part D, which covers medications, sees the treatment of ED as lifestyle-enhancing rather than medically necessary. (medicalnewstoday.com)
  • Part B of original Medicare generally covers 100% of the Medicare-approved cost for diabetes screenings. (medicalnewstoday.com)
  • If a person has diabetes and a high chance of developing glaucoma , original Medicare Part B will cover an annual eye exam. (medicalnewstoday.com)
  • The greatest allure of Medicare Advantage plans is that they have annual out-of-pocket limits for what would normally be covered under Part A and Part B of original Medicare, thus giving seniors some degree of confidence as to what their maximum medical costs could be. (foxbusiness.com)
  • Original Medicare has no out-of-pocket limit, which is where a supplemental insurance plan could come into pay. (foxbusiness.com)
  • Consumers are not allowed to unenroll from original Medicare and sign up for a Part C plan during this period. (foxbusiness.com)
  • When you use original Medicare (parts A and B together), the surgery is often covered under Part B . This is because hernia surgery is generally performed as an outpatient procedure, and Part B is medical insurance. (healthline.com)
  • It covers the out-of-pocket costs of original Medicare. (healthline.com)
  • Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance). (healthline.com)
  • They're required to cover everything original Medicare does, and they often cover more. (healthline.com)
  • Medicare managed plans are an alternative to original Medicare (parts A and B). Sometimes referred to as Medicare Part C or Medicare Advantage, Medicare managed care plans are offered by private companies. (healthline.com)
  • For example, plans must cover all the same services as original Medicare. (healthline.com)
  • These plans cover everything original Medicare does, and they often cover additional services as well. (healthline.com)
  • Medicare Part C, also known as Medicare Advantage, is a private alternative to Original Medicare (Parts A and B) offered by private insurance companies. (benzinga.com)
  • Medicare Supplement plans are private insurance plans that you can purchase to help cover the 'gaps' or out of pocket costs you owe under Original Medicare (Part A and B). (benzinga.com)
  • Whether you choose Original Medicare (Parts A and B) or opt for the added benefits of Medicare Advantage (Part C), there are options to suit your specific healthcare needs. (benzinga.com)
  • Medicare open enrollment ends Thursday! (aarp.org)
  • Medicare Open Enrollment Ends Dec. 7. (nbcsandiego.com)
  • With Medicare's open enrollment underway, health experts are warning older adults about an uptick in misleading marketing tactics that might lead some to sign up for Medicare Advantage plans that don't cover their doctors or prescriptions and drive up their out-of-pocket costs. (nbcsandiego.com)
  • When you request a Medicare patient's eligibility status, we either give the dates they may get certain preventive services or give you data to help determine the next eligible date. (cms.gov)
  • Find more information in this tool's FAQs or the Checking Medicare Eligibility fact sheet. (cms.gov)
  • So you must sign up with Medicare in order to maintain eligibility for TFL. (aarp.org)
  • Older employees are working longer, and the gap between the age for Medicare eligibility (65) and normal retirement age (soon to be 67) is increasing. (shrm.org)
  • If employers have not already fielded questions about Medicare enrollment penalties, whether Medicare or the employer plan is the primary or secondary payer of health claims, and how Medicare eligibility impacts health savings accounts (HSAs), they likely will in the future. (shrm.org)
  • The key communication issue for most Medicare-eligible employees focuses on how Medicare overlaps with employer-provided health plans,' said Gary Kushner, president and CEO of HR and benefits consulting firm Kushner & Company in Portage, Mich. The impact of Medicare eligibility on the ability to make tax-deductible HSA contributions is another key communication point. (shrm.org)
  • Medicare Eligibility: Who Is Eligible For Medicare? (forbes.com)
  • Democratic presidential nominee Joseph Biden released a plan earlier this year that would lower Medicare eligibility to 60. (insure.com)
  • Can I delay Part B enrollment after I become eligible for Medicare, without risking late penalties? (aarp.org)
  • If you're married and your FEHB plan covers your spouse, he or she can also delay Medicare enrollment until your employment ends. (aarp.org)
  • There are essentially two major enrollment periods for Medicare. (foxbusiness.com)
  • This is a time outside of the yearly enrollment windows when you can change your Medicare plan. (healthline.com)
  • Enrollment in these plans depends on the plan's contract renewal with Medicare. (uhc.com)
  • In the Achieving a Better Life Experience Act of 2014, Congress required the CMS to identify "misvalued" CPT codes and reduce reimbursement for those that are overvalued with a target of reductions equaling 1% of total physician Medicare reimbursements for calendar year 2016 and 0.5% for each of 2017 and 2018. (medscape.com)
  • Medicare sets the tone on price and reimbursement, and everyone follows suit," Gupta said. (medscape.com)
  • Because claims are processed by Medicare administrative contractors, it can take about a month for the approval or denial process and for doctors to receive reimbursement. (medscape.com)
  • That's the prediction from some advocates for the profession who say that a series of unprecedented cuts to Medicare reimbursement for glaucoma and retinal detachment surgery may change the way physicians approach these conditions. (medscape.com)
  • Cite this: How Medicare Reimbursement Cuts Are Reshaping Ophthalmology - Medscape - Dec 23, 2015. (medscape.com)
  • Some Medicare Advantage plans do. (medscape.com)
  • Prior authorizations, especially with Medicare Advantage plans, are also problematic. (medscape.com)
  • Medicare Advantage is a popular program among seniors that already allows them to turn traditional Medicare into private insurance by contracting with an insurer. (foxnews.com)
  • Or, you can choose Medicare Advantage (also known as Part C). (aarp.org)
  • What is Medicare Advantage? (aarp.org)
  • Do Medicare Advantage plans include both Part A and Part B? (aarp.org)
  • Where do I find information about the Medicare Advantage plans in my area? (aarp.org)
  • Medicare Advantage plans are available in most parts of the United States. (aarp.org)
  • I have a Medicare Advantage plan. (aarp.org)
  • Medicare Advantage plans cover all Medicare-covered services and must include both Part A and Part B benefits. (aarp.org)
  • Before you choose a Medicare Advantage plan, consider carefully the many options these plans offer. (aarp.org)
  • What are my options if my Medicare Advantage plan is ending at the end of this year? (aarp.org)
  • If I have problems with my Medicare Advantage plan, can I switch plans? (aarp.org)
  • Does Medicare Advantage cover Viagra? (medicalnewstoday.com)
  • The brief also examines market share for the companies offering Medicare Advantage plans and the role Medicare Advantage plans play in providing employer-sponsored retiree health benefits. (kff.org)
  • Medicare Advantage plans have grown significantly in popularity over the past decade. (foxbusiness.com)
  • Medicare Advantage plans are also lauded for their convenience and compactness. (foxbusiness.com)
  • However, missing out on the possibility of enrolling in a Medicare Advantage plan could be the least of your concerns. (foxbusiness.com)
  • Part C refers to Medicare Advantage plans offered by Medicare-approved insurance companies in lieu of 'standard' Medicare. (shrm.org)
  • Depending on where you have your surgery, you might be covered under Medicare Part A, Medicare Part B, or your Medicare Advantage plan. (healthline.com)
  • Medicare Part C. Medicare Part C is also known as Medicare Advantage. (healthline.com)
  • Medicare managed care plans are often known as Medicare Part C or Medicare Advantage plans. (healthline.com)
  • Managed care plans are also referred to as Medicare Part C (Medicare Advantage) plans. (healthline.com)
  • The company wants to increase its presence in Medicare plans to capitalize on the post-war baby-boom population becoming eligible for the program, but WellPoint said its Medicare Advantage plans had enrolled many sicker seniors who use more services and therefore have higher costs. (ibtimes.com)
  • The company said it would change its strategy for its Medicare Advantage plans for next year. (ibtimes.com)
  • The Biden administration has proposed a ban on misleading ads for Medicare Advantage plans that have targeted older Americans and, in some cases, convinced them to sign up for plans that don't cover their doctors or prescriptions. (nbcsandiego.com)
  • Medicare Advantage Plans and prescription drug plans often make changes from year to year, which means it's worthwhile evaluating your costs for next year. (nbcsandiego.com)
  • Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. (uhc.com)
  • Medicare Advantage plans combine the benefits covered under Parts A and B into a single plan. (benzinga.com)
  • Medicare Advantage plans typically have a network of preferred healthcare providers, offering coordinated care and potentially lower out-of-pocket costs. (benzinga.com)
  • Plus, there are Medicare Advantage plans that include extras such as meal deliveries, home helpers, and transportation to doctor appointments. (anthem.com)
  • New policy series from the Medicare Rights Center helps individuals better understand Medicare Advantage and its role within the Medicare system. (medicareinteractive.org)
  • Starting January 1, 2024, people with limited resources can qualify for even more savings on Medicare drug costs (Part D). Find out if you qualify and how much you can save. (medicare.gov)
  • ACP said that many of the provisions in the proposed 2024 Medicare Physician Fee Schedule will better recognize the value of internal medicine and improve continuity of care. (acponline.org)
  • Medicare Changes In 2024: What's New? (forbes.com)
  • Now, 86-years-old and still in good health, Anna herself has been the beneficiary of the art of medicine that Medicare has allowed me (as well as her cardiologist, diabetes specialist, and vascular surgeon) to practice. (foxnews.com)
  • The term " patient " refers to a Medicare beneficiary. (cms.gov)
  • This penalty will follow you around for as long as you're enrolled in Medicare (i.e., for the rest of your life), and it could increase on a year-over-year basis since the base beneficiary premiums increase with the inflation rate. (foxbusiness.com)
  • A federal district judge has ruled that the Bush administration violated federal law by failing to send comparative information on the available Medicare health plans to each beneficiary last year. (elderlawanswers.com)
  • At the beginning of the year , the healthcare industry moved away from Medicare identifiers based on Social Security Numbers (SSNs), in favor of more secure Medicare Beneficiary Identifiers (MBIs) . (experian.com)
  • According to the indictment, one of the defendants sold Medicare beneficiary information to 100 different Houston-area home health care agencies, and the agencies used that information to bill Medicare for services that were unnecessary or not even provided. (fbi.gov)
  • Results show that over the period from 2010-2019, anesthesia delivery models utilized under Medicare Part B have become increasingly oriented around the use of CRNAs. (bvsalud.org)
  • There's a chance that your Medicare Part B premiums for 2022 could be reduced. (cnbc.com)
  • It is not clear that restricting Medicare choices by cutting doctor and hospital reimbursements for procedures that are deemed unnecessary by the new Medicare board will save money if it leads to doctors dropping out and patients becoming sicker if they end up with less access to timely care. (foxnews.com)
  • Most people don't have to pay a monthly payment, called a premium, for Part A. This is because they or a spouse paid Medicare taxes while they were working. (hhs.gov)
  • Medicare is the publicly funded universal health care insurance scheme in Australia, along with the Pharmaceutical Benefits Scheme (PBS) operated by the nation's social security department, Services Australia. (wikipedia.org)
  • Medicare doesn't cover eye health (except for eye exams for diabetes patients), which is an issue for Daniel Laroche, MD, a glaucoma specialist and clinical associate professor of ophthalmology at Mount Sinai Medical Center in New York City. (medscape.com)
  • In intervention areas, influenza vaccine was supplied without cost to Medicare providers by local health departments using computerized vaccine monitoring and distribution systems. (cdc.gov)
  • Introducing more choice instead, as the Romney-Ryan plan does, by allowing Medicare patients to use their allotted money to buy private health insurance, is an idea that makes sense and is more in keeping with what's best about our health care system. (foxnews.com)
  • To begin your search for a plan, use the Medicare Plan Finder at www.medicare.gov/find-a-plan , or contact your local State Health Insurance Assistance Program (or SHIP) at www.shiptacenter.org. (aarp.org)
  • Medicare is the principal way Australian citizens and permanent residents access most health care services in Australia. (wikipedia.org)
  • All Australian citizens and permanent residents have access to fully-covered health care in public hospitals, funded by Medicare (through the National Health Pool), as well as state and federal contributions. (wikipedia.org)
  • Many specialties and allied health services are partially covered by Medicare, including psychology and psychiatry, ophthalmology, physiotherapy and audiology, with the exception of dental services. (wikipedia.org)
  • Services not covered by Medicare may be partially supported by private health insurance, which the Australian Government subsidises for most Australians. (wikipedia.org)
  • Medicare may cover diabetes self-management training if a person is at risk of health complications due to the condition. (medicalnewstoday.com)
  • Under IRS rules, you cannot contribute to a health savings account (HSA) at work in any month that you are enrolled in any part of Medicare. (aarp.org)
  • As a result, employers are more likely to have Medicare-eligible employees on the payroll and participating in their employee health benefit plans. (shrm.org)
  • Vendors, especially those involved in administering health plans and HSAs, can also provide helpful information for Medicare-eligible employees. (shrm.org)
  • The Medicare program is critical to ensuring that the elderly and others in the United States are able to access necessary health care. (acponline.org)
  • Nearly all physicians in the United States participate in the Medicare program, meaning its role as a payer is influential across the entire health care system. (acponline.org)
  • If you'll still be working at 65, it's extremely important to double-check how your workplace health insurance plan coordinates with Medicare. (newsday.com)
  • There is no charge for Part A. But people who are covered by Medicare can't contribute to an HSA -- a tax-sheltered savings account only available to people who have a high deductible health insurance policy. (newsday.com)
  • But when your employer has fewer than 20 workers, Medicare becomes your primary health insurance at 65. (newsday.com)
  • The outbreak of severe acute respiratory syndrome (SARS) this spring awakened policymakers' attention to health and medicare problems for rural people. (chinadaily.com.cn)
  • Medicare for all remains the top health care plan in a new Insure.com survey of 1,500 people, though nearly as many people also back keep everything the same. (insure.com)
  • A recent testimony before a U.S. Senate subcommittee by Dr. Danielle Martin, former head of the Canadian Doctors for Medicare, has given Canadians the chance to indulge in what may be a favourite pastime - criticizing the American health care system. (fraserinstitute.org)
  • Administrative cost cuts helped WellPoint, the No. 2 health insurer by market value, offset higher medical claim costs for its Medicare business. (ibtimes.com)
  • Researchers at UC San Diego and other institutions have found that private health insurers that sponsor Medicare Part D are artificially inflating the costs of certain generic drugs by overpaying pharmacies, it was announced Tuesday. (nbcsandiego.com)
  • In other words, Medicare looking less bad is simply another proof of how crappy our health care, or more accurately, health insurance system is. (nakedcapitalism.com)
  • The only exception is you may be able to delay starting Medicare until after you are 65 if you are in an employer group health plan. (nakedcapitalism.com)
  • Medicare Part A covers hospital services, skilled nursing facility care, hospice care, and some home health services. (benzinga.com)
  • Medicare also typically covers short-term home health services if a doctor prescribes care for a person who is homebound. (anthem.com)
  • In Houston, two individuals were charged today with Medicare fraud schemes involving $62 million in false claims for home health care and durable medical equipment. (fbi.gov)
  • The Medicare Fraud Strike Force, coordinated jointly by the Department of Justice (DOJ) and the Department of Health and Human Services (HHS), is a multi-agency team of federal, state, and local investigators who combat Medicare fraud by analyzing data about the problem and putting an increased focus on community policing. (fbi.gov)
  • In Miami, 45 individuals-including a doctor and a nurse-were charged for their participation in various fraud schemes involving a total of $159 million in fraudulent Medicare billings in the areas of home health care, mental health services, occupational and physical therapy, durable medical equipment, and HIV infusion. (fbi.gov)
  • In addition to our role on the Medicare Fraud Strike Force, the FBI also operates health care fraud task forces or working groups in all 56 of our field offices. (fbi.gov)
  • The new Medicare plan is far too difficult to make sense of, which is why I have chosen to die earlier than I had initially planned. (theonion.com)
  • This is the traditional fee-for-service plan provided by Medicare. (aarp.org)
  • Medicare Plan F: What Is It And How Does It Work? (forbes.com)
  • Notwithstanding your group plan, you'll probably have to sign up for Medicare Part B, too. (newsday.com)
  • One of the biggest changes is that people who are eligible for Medicare through a diagnosis of end stage renal disease (ESRD) are now able to purchase a managed care plan. (healthline.com)
  • Your Medicare plan provider is required to send an Annual Notice of Change letter indicating changes to your Medicare plan benefits or costs and providers each fall. (uhc.com)
  • Merck is suing the federal government over a plan to negotiate Medicare drug prices, calling the program a sham equivalent to extortion. (nbcsandiego.com)
  • The Democratic president is beginning with his plan for Medicare, including higher taxes on wealthy people to increase funding for the program's trust fund. (nbcsandiego.com)
  • Medicare Plan Expert is a licensed insurance sales agent/producer. (uhc.com)
  • The Right Plan Promise is our commitment to provide you with tools and agent/producer support to help you find a plan in UnitedHealthcare's Medicare plan portfolio that meets your needs. (uhc.com)
  • Comparing Anthem's Medicare plan types and their benefits can also help you and your loved ones understand options that might be a good fit. (anthem.com)
  • If you're providing care and support to someone with an Anthem Medicare plan, you can be added as a caregiver to their account. (anthem.com)
  • Do I need to sign up for Medicare Part B when I turn 65? (aarp.org)
  • For example, as per Medicare , after patients meet their Part B deductible, they pay 20% of the Medicare-approved amount for glaucoma testing. (medscape.com)
  • AARP's Medicare Question and Answer Tool is a starting point to guide you through the different Medicare plans. (aarp.org)
  • Which Medicare plans may be best for you if you know you need hernia surgery? (healthline.com)
  • Medicare managed care plans are offered by private companies that have a contract with Medicare. (healthline.com)
  • Plans are offered by private companies overseen by Medicare. (healthline.com)
  • What are the types of Medicare managed care plans? (healthline.com)
  • You can choose from among a few kinds of Medicare managed care plans. (healthline.com)
  • There are a few changes to Medicare managed care plans in 2021. (healthline.com)
  • Which parts of Medicare are included in managed care plans? (healthline.com)
  • But in the quarter, profit in its business that include Medicare plans tumbled 41.3 percent. (ibtimes.com)
  • Congress has passed legislation allowing enrollees in Medicare managed care plans to return to regular Medicare or change plans at any time over the next three years, delaying restrictions that were scheduled to take effect this year. (elderlawanswers.com)
  • Requests to disenroll or change plans remain subject to applicable Medicare regulations and Federal and state laws/regulations. (uhc.com)
  • One of my friends plans to leave New York at 65, and the timing is driven by Medicare. (nakedcapitalism.com)
  • When Medicare started, the concept of the program was good," said Rahul Gupta, MD, a geriatrician in Westport, Connecticut, and chief of internal medicine at St. Vincent's Medical Center in Bridgeport. (medscape.com)
  • However, over the years, with new developments in medicine and the explosion of the Medicare-eligible population, the program hasn't kept up with coverages. (medscape.com)
  • Criticized as needlessly confusing, the new Medicare prescription-drug program, Medicare Part D, went into effect this week. (theonion.com)
  • The FEHB program does not require you to sign up for Medicare Part B, but you may want to consider some factors before making the decision. (aarp.org)
  • Medicare has the bad rap of being a big, bloated government program, but it's not because it's overpaying doctors. (cnn.com)
  • To this end, the Medicare program has been tremendously successful. (nga.org)
  • Medicare officials are expected this week to issue a preliminary determination of whether or to what extent the program will cover the drug. (cnbc.com)
  • It would be unprecedented, but in this situation it may not be unwarranted,' said Juliette Cubanski, deputy director of the program on Medicare policy at the Kaiser Family Foundation. (cnbc.com)
  • Part A covers Medicare inpatient care received while in a hospital, a skilled nursing facility and, in limited circumstances, at home, and most people are not charged a monthly premium . (shrm.org)
  • Medicare Part A helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities (not custodial or long-term care). (hhs.gov)
  • Medicare will cover hernia surgery whether you have it as an inpatient or outpatient. (healthline.com)
  • I have long gotten used to the fact that Medicare pays me less than private insurance does, and that I write more prescriptions and order more tests for elderly patients with more medical problems. (foxnews.com)
  • In Florida, for instance, a doctor doing a colonoscopy in his office will receive $395 for a Medicare patient, but only $342 for one covered by private insurance. (cnn.com)
  • Medicare Part A, on the other hand, is hospital insurance. (healthline.com)
  • Medicare Part A. Medicare Part A is hospital insurance. (healthline.com)
  • Medicare Part B. Medicare Part B is medical insurance. (healthline.com)
  • Two new consumer booklets from the Medicare Rights Center explain how Medicare dovetails with private insurance and how to appeal Medicare decisions. (elderlawanswers.com)
  • I am particularly dreading going on Medicare because I am in the microscopically small minority that has good and cheap private insurance. (nakedcapitalism.com)
  • None of my current physicians accept Medicare, while my current insurance covers them. (nakedcapitalism.com)
  • With the largest network of insurance payors - including Medicare, Commercial and Managed Care expertise - Apria's team will work proactively with your insurance carrier and work on your behalf to get equipment and services covered. (apria.com)
  • Nearly 70 percent of these cases involve government-sponsored programs, like Medicare, since the Bureau is the primary investigative agency with jurisdiction over federal insurance programs. (fbi.gov)
  • Imagine what will happen as the new cuts take place: hospitals will struggle and doctors will quit Medicare. (foxnews.com)
  • Consider this: Studies from Drs. Wu and Chen at Tulane have shown that large Medicare cuts to hospitals result in increasing death rates among patients. (foxnews.com)
  • Physicians lose an estimated 7.3% of Medicare claims to billing problems. (medscape.com)
  • We've put together resources to help everyone understand the new policies in order to help patients get qualified claims covered by Medicare, rather than denied. (apria.com)
  • A total of 91 individuals were charged with various Medicare fraud-related offenses, including fraudulent billings of approximately $295 million, the largest amount in phony claims involved in a single takedown in Strike Force history. (fbi.gov)
  • Medicare data reports diabetes-associated conditions highlighted in claims from Medicare. (cdc.gov)
  • Medicare pays physicians about 80% of the "reasonable charge" for covered services. (medscape.com)
  • At the same time, private insurers pay nearly double Medicare rates for hospital services. (medscape.com)
  • This educational tool helps you properly provide and bill Medicare preventive services. (cms.gov)
  • When can CMS add new Medicare preventive services? (cms.gov)
  • The list of services covered, the standard operating fee for the service, and the portion of that fee covered, is set out in the Medicare Benefits Schedule (MBS). (wikipedia.org)
  • Australia's Medicare scheme operates under power granted to the federal Parliament by Section 51 of the Australian Constitution, enacted by the 1946 Australian referendum (Social Services). (wikipedia.org)
  • What other diabetes services does Medicare Part B cover? (medicalnewstoday.com)
  • You'll pay 20 percent of the cost of services when you use Medicare Part B. Medicare will pay the other 80 percent. (healthline.com)
  • Working together, we can help your patients get the equipment and services they need, while ensuring that Medicare guidelines are met. (apria.com)
  • Read on to gain insight into the valuable healthcare benefits available through Medicare. (benzinga.com)
  • Extensive Medicare experience as well as the largest network of payor contracts, helps ensure that Apria is positioned to provide care to more patients than any other healthcare provider. (apria.com)
  • Helping someone else make decisions about Medicare and their healthcare needs can be challenging. (anthem.com)
  • Private insurers allow an average of $1,226 for low-back disc surgery, while Medicare will only permit $654, for instance. (cnn.com)
  • The cost-effectiveness indices were calculated using morbidity and mortality data from the demonstration and published studies and compared with cost-effectiveness of other Medicare benefits. (cdc.gov)
  • Medicare doesn't negotiate rates. (cnn.com)
  • Medicare only covers gynecologist visits every 2 years after the age of 65," she said. (medscape.com)
  • Medicare will pay its share of the charge for each service it covers. (aarp.org)
  • This article discusses whether Medicare covers Viagra, the costs of Viagra, the drug's generic alternatives, and how Viagra works. (medicalnewstoday.com)
  • Medicare Part D , which covers prescription drugs, also covers diabetes supplies. (medicalnewstoday.com)
  • Medicare covers any hernia surgery that's medically necessary. (healthline.com)
  • Medicare covers multiple types of hernia surgery if they're medically necessary. (healthline.com)
  • Most of these patients are age 65 or older and generally enrolled in Medicare, which covers more than 63 million individuals. (cnbc.com)
  • While physicians are getting less of a Medicare pay cut than they thought this year (Congress voted to cut Medicare payments by 2%, which was less than the expected 8.5%), Medicare still pays physicians only 80% of what many third-party insurers pay. (medscape.com)
  • Worse, inflation makes continuous cuts feel even steeper and trickles down to physicians and their patients as more and more doctors become disenchanted and consider dropping Medicare. (medscape.com)
  • Physicians who accept Medicare can choose to be a "participating provider" by agreeing to the fee schedule and to not charging more than this amount. (medscape.com)
  • Physicians can also opt out of Medicare entirely. (medscape.com)
  • Both a 2010 American Medical Association (AMA) survey and the 2011 National Ambulatory Medical Care Survey found that about 17 percent of physicians were already restricting the number of Medicare patients they treat even before ObamaCare. (foxnews.com)
  • The American College of Physicians advocates to ensure that Medicare meets the needs of internal medicine physicians and their patients. (acponline.org)
  • Without more privatization of Medicare, I am worried that the time will be coming soon when I simply won't be able to afford to take care of my friend Anna or patients like her. (foxnews.com)
  • But the law - or the fear of it - now can stand in the way of what CMS describes as value-based arrangements at a time of increasing emphasis on pegged Medicare payment to judgements about the quality of care delivered. (medscape.com)
  • And doctors might be okay getting less per procedure because Medicare patients tend to need a lot of care. (cnn.com)
  • What Is Medicare Managed Care? (healthline.com)
  • With more than 1,800 managed care contracts nationwide, should you become Medicare-eligible, or transition from Managed Medicare to traditional fee-for-service Medicare Part B, you may continue to be serviced by Apria without interruption. (apria.com)
  • In general, Medicare doesn't cover expenses for in-home caregivers to provide personal care and housekeeping, if medical care isn't needed. (anthem.com)
  • Medicare does cover short-term caregiving expenses if someone needs medical care following a surgery, illness, or injury. (anthem.com)
  • A person will generally pay the deductible for Part B, then 20% of the Medicare-approved amount. (medicalnewstoday.com)
  • If you (or your spouse) didn't pay Medicare taxes while you worked and you are age 65 or older, you may be able to buy Part A. (hhs.gov)
  • Any additional testing requires authorization, and Medicare doesn't cover hormone replacement at all, which really makes me crazy. (medscape.com)
  • A 2011 survey by the Texas Medical Association revealed that a full half of Texas doctors are planning on dropping Medicare. (foxnews.com)
  • A recent survey from the Doctors Patients Medical Association found that 74 percent of doctors say that they will stop accepting Medicare patients due to the restrictions of ObamaCare. (foxnews.com)
  • If a person meets the criteria, Medicare Part B will cover insulin pumps and insulin, while Part D will cover prescribed insulin and related medical supplies. (medicalnewstoday.com)
  • In this case, Medicare considers the pump to be durable medical equipment (DME). (medicalnewstoday.com)
  • China is launching an unprecedented project to build up a cooperative medicare system within eight years in rural areas, which will cover 900 million farmers with medical financial assistance and free them from worries of being unable to afford a cure. (chinadaily.com.cn)
  • Under this new medicare system, cooperative medical funds will be set up in rural areas with money from three parties: the central government, local governments and farmers themselves. (chinadaily.com.cn)
  • Rather than pay for them fully out of pocket, or have to get new NYC doctors (and she does not like the look of the choices), she will move to a biggish city in Flyover that had a good medical center and sign up for its HMO via Medicare Part B. (nakedcapitalism.com)
  • We are committed to maintaining close ties with the medical community and to serving as an ongoing source of information when it comes to Medicare documentation requirements. (apria.com)
  • Your costs will also depend on where you're having your surgery and what part of Medicare you're using. (healthline.com)
  • Does Medicare cover viagra? (medicalnewstoday.com)
  • Does Medicare Part D cover Viagra? (medicalnewstoday.com)
  • Medicare does not cover Viagra and similar drugs for the treatment of ED. (medicalnewstoday.com)
  • However, Medicare may cover sildenafil and other generic medications for ED to treat other medically necessary conditions. (medicalnewstoday.com)
  • Does Medicare cover insulin pumps? (medicalnewstoday.com)
  • Medicare Part B does not cover insulin unless a person is medically required to use an insulin pump. (medicalnewstoday.com)
  • If a person's doctor believes that it is necessary, Medicare may cover two screenings per year. (medicalnewstoday.com)
  • If a person has nerve damage in one or both feet due to diabetes, Medicare Part B may cover a foot exam every year . (medicalnewstoday.com)
  • If a person meets three conditions, Medicare Part B may also cover a pair of therapeutic shoes. (medicalnewstoday.com)
  • Medicare is made up of a number of parts that gel together to cover our nation's elderly. (foxbusiness.com)
  • Does Medicare Cover Hernia Surgery? (healthline.com)
  • Medicare will cover hernia surgery as long as it's medically necessary. (healthline.com)
  • If you need hernia surgery, Medicare will cover it as long as it's considered medically necessary. (healthline.com)
  • So, as long as your doctor determines that surgery is the best way to treat your hernia, Medicare will cover it. (healthline.com)
  • You need to pay this before Medicare will cover your surgery. (healthline.com)
  • Does Medicare Cover CPAP Machines? (forbes.com)
  • The central government was determined to set up an effective cooperative system to offer medicare for 900 million farmers and the system is scheduled to be expanded to cover all farmers by 2010. (chinadaily.com.cn)
  • I get paid less for Medicare patients by about 20% because of 'lesser-of' payments," said Laroche. (medscape.com)
  • It would be nice to get the full amount for Medicare patients. (medscape.com)
  • For office visits by established patients, for instance, Medicare will allow 92% of what insurers do. (cnn.com)
  • Assisting Medicare patients with tracking down their MBIs was time-consuming and error-prone. (experian.com)
  • Medicare Interactive Pro (MI Pro) is an online curriculum designed to empower any professional to help their clients, patients, employees, retirees, and others navigate Medicare questions. (medicareinteractive.org)
  • Nous avons utilisé un questionnaire en 4 parties couvrant la démographie, la satisfaction, les besoins des patients et l'état de santé mentale. (who.int)
  • You can't opt out of Medicare unless you give up your Social Security too. (nakedcapitalism.com)
  • Because Medicare is a horribly complex and half privatized, it's a sign of Stockholm Syndrome that Medicare for All is the preferred branding for single payer when Medicare is no such thing. (nakedcapitalism.com)
  • Medicare usually does not pay for Viagra and similar drugs, such as Cialis and Levitra, that people use to treat sexual dysfunction. (medicalnewstoday.com)
  • Like other people who work for large employers after age 65, you can delay signing up for Medicare until you retire. (aarp.org)
  • Medicare spending goes up because people use it more," he said. (cnn.com)
  • In addition, Medicare has given American families the assurance that they will not have to bear by themselves the burden of illness of their elderly or disabled parents or other family members. (nga.org)