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A
Accountable Care Organizations (ACO)
Accountable Care Organizations (ACOs) are collaborative networks of healthcare providers, including hospitals, physicians, and other healthcare professionals, working together to deliver high-quality, coordinated care to patients. The goal of ACOs is to improve patient outcomes while controlling costs by emphasizing…
Activities of Daily Living (ADL)
Activities of Daily Living (ADL) refer to routine self-care tasks necessary for maintaining independence and functioning in daily life. These include activities such as bathing, dressing, grooming, eating, toileting, and mobility.
Acute Illness
Acute illness denotes a rapid-onset health condition typically characterized by severe symptoms requiring urgent medical intervention. These illnesses can include infections, injuries, or exacerbations of chronic conditions and often necessitate prompt diagnosis and treatment.
Administrative Law Judge
An Administrative Law Judge (ALJ) serves as an impartial adjudicator responsible for presiding over administrative hearings and resolving legal disputes between individuals and government agencies. They ensure fair and equitable decisions are made in accordance with applicable laws and regulations.
Advance Beneficiary Notice of Noncoverage (ABN)
The Advance Beneficiary Notice of Noncoverage (ABN) is a document issued by healthcare providers to Medicare beneficiaries, informing them in advance of potential services or items that Medicare may not cover under specific circumstances. It serves as a notification of…
Advance coverage decision
An advance coverage decision is a pre-approval process provided by Medicare or private insurance plans to determine coverage for specific healthcare services or items before they are received or obtained. This process allows beneficiaries or healthcare providers to seek clarification…
Advance directive
An advance directive is a legal document that allows individuals to outline their healthcare preferences and decisions in advance, particularly for situations where they may become unable to communicate or make decisions due to illness or incapacitation. These directives typically…
Advanced Illness
Advanced illness refers to the later stages of a serious health condition where the disease has significantly progressed, typically beyond the point of cure. Patients with advanced illnesses often experience complex symptoms and require comprehensive care aimed at enhancing quality…
Affordable Care Act (also known as the Health Care Law)
The Affordable Care Act (ACA), commonly known as the Health Care Law, is a comprehensive healthcare reform enacted in 2010 in the United States. Its primary goals are to increase access to health insurance, improve the quality of healthcare, and…
ALS
Amyotrophic Lateral Sclerosis (ALS), often referred to as Lou Gehrig's disease, is a progressive neurodegenerative disorder that affects nerve cells in the brain and spinal cord. As motor neurons deteriorate, voluntary muscle control diminishes, leading to muscle weakness, twitching, and…
Ambulatory surgical center
An ambulatory surgical center (ASC) is a specialized healthcare facility where surgical procedures are performed on an outpatient basis. Unlike traditional hospitals, ASCs focus solely on providing same-day surgical care, allowing patients to undergo procedures and return home on the…
Ambulette
An ambulette, short for "ambulance-ette," is a specialized vehicle designed to transport individuals who are medically stable but have mobility challenges. Unlike ambulances, which are equipped to handle medical emergencies, ambulettes are primarily used for non-emergency medical transportation, such as…
Annual Election Period (AEP)
The Annual Election Period (AEP), also known as the Medicare Open Enrollment Period, is the time frame during which Medicare beneficiaries can make changes to their health and prescription drug coverage. It typically occurs from October 15th to December 7th…
Annual Notice of Change (ANOC)
The Annual Notice of Change (ANOC) is a document that Medicare Advantage and Medicare Part D plan providers are required to send to their members every year before the Annual Election Period. The ANOC outlines any changes in coverage, costs,…
Annual Wellness Visit (AWV)
The Annual Wellness Visit (AWV) is a preventive healthcare service covered by Medicare that allows beneficiaries to discuss their overall health and wellness with their healthcare provider. During the AWV, the provider assesses the individual's health status, develops or updates…
Appeal
An appeal is a legal or formal process through which individuals or entities contest a decision made by a court, administrative agency, or other authority. It involves requesting a review of the decision, typically based on errors in law, procedure,…
Approved Amount
Approved Amount refers to the highest fee that Medicare agrees to pay for a covered medical service or supply. It's often lower than the actual amount charged by healthcare providers, and beneficiaries may be responsible for paying the difference, known…
Area Agency on Aging (AAA)
Area Agencies on Aging (AAA) are local or regional organizations dedicated to enhancing the quality of life for older adults and their families. They offer a wide range of services and resources, including transportation, meal assistance, caregiver support, and information…
Assets
Assets encompass all tangible and intangible resources owned by an individual or entity, which hold economic value and contribute to their net worth. This includes cash, property, investments, vehicles, stocks, bonds, intellectual property, and any other valuable possessions.
Assignment
Assignment refers to the transfer of rights, interests, or obligations from one party to another. This can involve various legal contexts, including contracts, leases, intellectual property, and insurance policies. In the realm of contracts, for instance, an assignment occurs when…
Assisted Living Facility
An Assisted Living Facility (ALF) is a residential option for older adults or individuals with disabilities who need some assistance with activities of daily living but do not require around-the-clock medical care. ALFs offer a supportive environment where residents can…
Assistive Technology
Assistive Technology (AT) encompasses a wide range of devices, equipment, and systems that assist people with disabilities in performing tasks they might otherwise find challenging or impossible. These technologies can include mobility aids like wheelchairs and walkers, communication devices, adaptive…
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B
Balance Billing
Balance billing occurs when a healthcare provider bills a patient for the difference between the provider's charge for a service and the allowed amount covered by the patient's insurance plan. This practice often happens when patients receive care from out-of-network…
Benchmark
In various contexts, a benchmark serves as a standard against which other things can be measured or evaluated. In finance, it could be a market index used to gauge the performance of investments. In business, it might refer to a…
Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)
Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) is an entity appointed by the Centers for Medicare & Medicaid Services (CMS) to ensure quality care for Medicare beneficiaries and their families. BFCC-QIOs work to improve healthcare outcomes, address complaints,…
Benefit period
A benefit period refers to the duration of coverage provided by Medicare for hospital stays. It begins the day you're admitted to a hospital as an inpatient and ends when you haven't received inpatient hospital care for 60 consecutive days.…
Benefits Coordination & Recovery Center
The Benefits Coordination & Recovery Center (BCRC) is a specialized division of the Centers for Medicare & Medicaid Services (CMS) responsible for managing Medicare coordination of benefits and recovery efforts. BCRC works to ensure that Medicare benefits are properly coordinated…
Bereavement Services
Bereavement services encompass a range of support and resources provided to individuals who are grieving the loss of a loved one. These services may include counseling, support groups, educational materials, and assistance with funeral arrangements. Bereavement services aim to help…
Brand-Name Drug
A brand-name drug is a medication that is marketed and sold under a proprietary, trademarked name by a pharmaceutical company. These drugs are typically developed and patented by the manufacturer, granting them exclusive rights to produce and sell the medication…
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C
Calendar Quarters
Calendar quarters refer to the four three-month periods within a calendar year, namely January to March (Q1), April to June (Q2), July to September (Q3), and October to December (Q4). These quarters are commonly used for financial reporting, planning, and…
Capped Rental Item
A capped rental item is medical equipment available through Medicare that is rented to beneficiaries for a set period. Once the rental cap is reached, ownership of the equipment typically transfers to the beneficiary. This rental arrangement ensures access to…
Care Manager
A care manager is a healthcare professional trained to coordinate and manage the care of individuals with complex medical needs or chronic conditions. They assess clients' health status, develop care plans, coordinate services, and advocate for their clients to ensure…
Caregiver
Caregivers are individuals who provide various forms of assistance and support to people who are unable to care for themselves fully. This assistance can include help with daily activities, medical care, emotional support, and household tasks. Caregivers may be family…
Catastrophic Coverage
Catastrophic coverage is a type of health insurance that provides protection against exceptionally high medical expenses. It typically kicks in after the insured individual has reached a predetermined out-of-pocket spending threshold. Once this threshold is met, catastrophic coverage begins, covering…
Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services responsible for administering and overseeing various healthcare programs, including Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). CMS…
Certificate of Medical Necessity (CMN)
A Certificate of Medical Necessity (CMN) is a document used by healthcare providers to justify the necessity of certain medical equipment or services for patients. Insurers often require a CMN to assess whether the requested equipment or service is medically…
Certified (certification)
Certification, often denoted as being "certified," is a formal process by which individuals demonstrate their expertise and proficiency in a particular field or skill set. It typically involves meeting specific education, training, and experience requirements, as well as passing an…
CHAMPVA
CHAMPVA, or the Civilian Health and Medical Program of the Department of Veterans Affairs, is a comprehensive healthcare benefits program administered by the U.S. Department of Veterans Affairs (VA). It provides coverage for certain healthcare services and supplies to eligible…
Chronic Illness
Chronic illness refers to a persistent and long-lasting health condition that requires ongoing medical management and treatment to maintain quality of life and prevent complications. These conditions often last for extended periods, if not a lifetime, and may include diseases…
Claim
A claim is a formal request submitted to an insurance company or payer for reimbursement of healthcare services provided to a patient. It includes information such as the patient's demographic details, diagnosis, treatment provided, and associated costs. Healthcare providers submit…
Clinical breast exam
A clinical breast exam (CBE) is a physical examination performed by a healthcare provider to detect any abnormalities or changes in the breast tissue. During a CBE, the provider visually inspects and palpates the breasts and surrounding areas to identify…
COBRA (Consolidated Omnibus Budget Reconciliation Act)
COBRA, the Consolidated Omnibus Budget Reconciliation Act, is a federal law that provides workers and their families the right to continue their employer-sponsored health insurance coverage for a limited time after experiencing certain qualifying events, such as job loss, reduction…
Coinsurance
Coinsurance is a cost-sharing arrangement in insurance policies where the policyholder and the insurance company share the costs of covered healthcare services. It typically involves the policyholder paying a percentage of the total cost of services, while the insurance company…
Competitive Bidding
Competitive bidding is a procurement method commonly used in business and government sectors, where vendors or suppliers submit bids or proposals to compete for contracts or projects. The process aims to ensure fairness, transparency, and cost-effectiveness by allowing multiple vendors…
Comprehensive outpatient rehabilitation
A Comprehensive Outpatient Rehabilitation Facility (CORF) provides a range of outpatient rehabilitation services to individuals recovering from illness or injury. These facilities offer various therapies, including physical therapy, occupational therapy, and speech-language pathology, tailored to meet the specific needs of…
Continuous Open Enrollment
Continuous open enrollment is a healthcare enrollment period that remains open throughout the year, allowing individuals to enroll in or make changes to their health insurance coverage outside of the traditional open enrollment period. This approach provides flexibility for individuals…
Conversion Policy
A conversion policy is an insurance option that enables policyholders to convert their existing insurance coverage into a different type of policy offered by the same insurer. This option is commonly available in life insurance, allowing policyholders to convert term…
Coordination of Benefits
Coordination of benefits is a process used to determine how multiple insurance plans, such as employer-sponsored coverage and Medicare, work together to cover healthcare expenses for an individual with dual coverage. The primary goal is to avoid overpayment and ensure…
Coordination Period, 30-Month
The 30-Month Coordination Period refers to the period following the start of Social Security Disability Insurance (SSDI) eligibility during which individuals with disabilities may receive Medicare coverage. This allows them access to essential healthcare services while awaiting the commencement of…
Copayment
A copayment, often referred to as a copay, is a predetermined fixed amount that patients are required to pay out-of-pocket for healthcare services covered by their insurance plan. Copayments are typically due at the time of service and can vary…
Cost Plan
Cost Plans are a type of Medicare plan offered by private insurance companies. These plans provide coverage for both Medicare Part A (hospital insurance) and Part B (medical insurance) services. Cost Plans offer flexibility in provider choice, allowing beneficiaries to…
Cost Tiers
Cost Tiers are categories used by insurance plans to classify prescription medications based on their cost to the patient. Typically, medications are grouped into tiers with different copayment or coinsurance amounts assigned to each tier. Lower-cost generic drugs are often…
Cost-sharing
Cost-sharing refers to the financial responsibility individuals have for a portion of their healthcare expenses beyond what is covered by insurance. This can include copayments, coinsurance, and deductibles, which are paid directly by the insured individual when receiving medical services.…
Coverage determination (Part D)
Coverage determination in Medicare Part D refers to the process by which Medicare evaluates and determines coverage for prescription drugs under Part D plans. This evaluation considers factors such as the drug's effectiveness, safety, and whether it's medically necessary for…
Coverage gap
The coverage gap, often referred to as the "donut hole," is a phase in Medicare Part D where beneficiaries may experience higher out-of-pocket costs for prescription drugs. After reaching a certain spending threshold, beneficiaries enter the coverage gap, where they…
Coverage Restrictions
Coverage restrictions are limitations or conditions imposed by insurance plans on the healthcare services or treatments they will cover. These restrictions may include requirements for preauthorization, limitations on the frequency or duration of services, or exclusions for certain treatments or…
Creditable coverage
Creditable coverage refers to healthcare coverage provided by an employer, union, or other entity that meets or exceeds the minimum standards set by Medicare. Individuals with creditable coverage may be eligible for special enrollment periods and may not face penalties…
Creditable coverage (Medigap)
Creditable coverage in the context of Medigap refers to health insurance coverage that meets or exceeds the minimum standards set by Medicare. This coverage includes benefits that are similar to those provided by Medicare Supplement Insurance (Medigap) plans. Individuals who…
Creditable prescription drug coverage
Creditable prescription drug coverage refers to prescription drug coverage provided by an employer, union, or other entity that meets or exceeds the minimum standards set by Medicare Part D. This coverage includes benefits that are comparable to or better than…
Critical access hospital (CAH)
A Critical Access Hospital (CAH) is a small, rural hospital designated by the Centers for Medicare & Medicaid Services (CMS) to provide essential healthcare services to underserved communities. CAHs play a crucial role in ensuring access to emergency and acute…
Curative Care
Curative care refers to medical interventions and treatments focused on curing or eliminating a disease, illness, or health condition. Unlike palliative care, which aims to relieve symptoms and improve quality of life in patients with chronic or terminal conditions, curative…
Current Work
Current work refers to the tasks, projects, or responsibilities that an individual or organization is presently engaged in or actively pursuing. It encompasses ongoing activities and initiatives, as well as immediate priorities and deadlines. Understanding one's current work is essential…
Custodial care
Custodial care refers to non-medical assistance provided to individuals who are unable to perform activities of daily living independently due to illness, injury, or age-related limitations. This type of care focuses on helping individuals with tasks such as bathing, dressing,…
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D
Deductible
A deductible is the amount of money an individual must pay out-of-pocket for covered healthcare services before their insurance plan begins to pay. It serves as a form of cost-sharing between the insured individual and the insurance provider. Once the…
Demand Bill
A demand bill is a notification sent to a patient requesting payment for medical services that were denied by their insurance company. When a claim is rejected or denied for reimbursement, healthcare providers may directly bill the patient for the…
Demonstrations
Demonstrations in healthcare refer to initiatives or programs implemented to test innovative models of care delivery, payment reform, or quality improvement strategies. These demonstrations are often conducted by government agencies, healthcare organizations, or research institutions to evaluate the effectiveness and…
Denial of Coverage
Denial of coverage occurs when an insurance provider refuses to pay for specific medical treatments or services requested by a policyholder. This decision may be based on various factors, including lack of medical necessity, policy limitations, or failure to meet…
Department of Veterans Affairs (VA)
The Department of Veterans Affairs (VA) is a federal agency responsible for administering programs and benefits to support veterans of the United States Armed Forces and their families. The VA provides a wide range of services, including healthcare, disability compensation,…
Detailed Explanation of Non-Coverage (DENC)
A Detailed Explanation of Non-Coverage (DENC) is a document provided by health insurance companies to policyholders to explain why a particular medical service or treatment was not covered under their insurance plan. The DENC typically outlines the reasons for the…
Detailed Notice of Discharge
A Detailed Notice of Discharge is a formal notification provided to patients or their representatives when they are discharged from a healthcare facility, such as a hospital or nursing home. This notice typically includes detailed information about the reasons for…
Dialysis
Dialysis is a life-sustaining treatment for individuals with kidney failure, also known as end-stage renal disease (ESRD). It involves the use of a machine to filter waste products, toxins, and excess fluid from the blood when the kidneys are no…
Diethylstilbestrol (DES)
Diethylstilbestrol (DES) is a synthetic estrogen that was prescribed to pregnant women in the mid-20th century to prevent miscarriage and other pregnancy complications. Despite being later found ineffective for these purposes, DES was widely used for several decades. Unfortunately, it…
Disability
Disability refers to a physical, mental, or cognitive impairment that substantially limits one or more major life activities, such as walking, seeing, hearing, or learning. Disabilities can be present from birth or acquired due to injury, illness, or aging. They…
Discharge
Discharge is the formal process of releasing a patient from a healthcare facility, such as a hospital or rehabilitation center, after receiving medical treatment or care. It involves providing instructions and necessary information to the patient and their caregivers for…
Discharge Plan
A discharge plan is a tailored and comprehensive strategy created by healthcare professionals to ensure a patient's smooth transition from a healthcare facility, such as a hospital or rehabilitation center, to home or another care setting. The discharge plan typically…
Disenrollment
Disenrollment refers to the voluntary withdrawal of an individual or family from participation in a health insurance plan or program. This may occur for various reasons, such as obtaining coverage through another plan, qualifying for different healthcare benefits, or no…
DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies)
DMEPOS, short for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, refers to a broad category of medical equipment and devices prescribed by healthcare providers to aid in the treatment or management of medical conditions. This includes items such as wheelchairs,…
Donut Hole
The Donut Hole, also known as the coverage gap, is a phase in Medicare Part D prescription drug plans where beneficiaries are responsible for a higher percentage of their medication costs. Once a beneficiary reaches the initial coverage limit, they…
Drug Class
A drug class refers to a group of medications that work in a similar manner to treat a specific medical condition or achieve a common therapeutic goal. Drugs within the same class typically share similar mechanisms of action, pharmacological effects,…
Drug Tiers
Drug tiers are a classification system used by insurance plans to categorize prescription medications based on their cost and coverage level. Typically, medications are assigned to different tiers, with lower-tier drugs having lower copayments or coinsurance amounts and higher-tier drugs…
Dual Eligible
Dual eligible refers to individuals who qualify for both Medicare, the federal health insurance program primarily for older adults and individuals with disabilities, and Medicaid, the joint federal and state program providing health coverage for low-income individuals. Dual eligible individuals…
Durable Medical Equipment (DME)
Durable Medical Equipment (DME) refers to medical devices and equipment prescribed by healthcare providers to assist individuals in managing medical conditions or disabilities at home. DME is designed to withstand repeated use and is appropriate for long-term use in a…
Durable Medical Equipment Medicare Administrative Contractor (DME MAC)
A DME MAC, or Durable Medical Equipment Medicare Administrative Contractor, is a private company contracted by the Centers for Medicare & Medicaid Services (CMS) to process claims and perform administrative tasks related to durable medical equipment (DME) under the Medicare…
Durable power of attorney
A durable power of attorney (DPOA) for healthcare is a legal document that grants an individual, known as the healthcare proxy or agent, the authority to make medical decisions on behalf of another person, known as the principal or patient,…
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E
Earned Income
Earned income refers to the money individuals receive from employment, such as wages, salaries, bonuses, and earnings from self-employment activities. It is the compensation received in exchange for labor or services provided. Earned income is a key component of personal…
Elimination Period
An elimination period, also known as a waiting or qualifying period, is the initial span of time during which an insured individual must wait before becoming eligible to receive benefits from an insurance policy. Common in disability and long-term care…
Employer Group Health Plan
An employer group health plan is a type of health insurance coverage offered by employers to their employees and often their dependents. These plans provide access to healthcare services, including medical, dental, and vision care, and are typically funded partially…
End-Stage Renal Disease (ESRD)
End-Stage Renal Disease (ESRD) is the final stage of chronic kidney disease, marked by a significant decline in kidney function to the point where the kidneys can no longer adequately perform their essential functions. Individuals with ESRD typically require dialysis…
Enrollment
Enrollment refers to the process of signing up for or joining a health insurance plan or program. During enrollment, individuals or groups typically provide personal information, choose a coverage option, and may be required to pay premiums or other fees.…
Enrollment Periods
Enrollment periods are specific time frames during which individuals can enroll in or make changes to their health insurance coverage. These periods are often established by insurance providers, employers, or government agencies and may vary depending on the type of…
Evidence of Coverage (EOC)
An Evidence of Coverage (EOC) is a document provided to individuals enrolled in a health insurance plan that outlines the terms, conditions, and benefits of the coverage. The EOC typically includes information about covered services, costs, exclusions, and limitations, as…
Exception
An exception refers to a deviation or variation from established rules, standards, or procedures. In the context of healthcare, exceptions may arise in various situations, such as coverage determinations, claims processing, or reimbursement policies. For example, an insurance company may…
Exception Request
An exception request is a formal appeal made by a policyholder or healthcare provider to an insurance company seeking coverage for a service or treatment that is not typically covered under the terms of the insurance policy. Exception requests are…
Excess charge
An excess charge refers to the additional amount that a healthcare provider may bill a patient beyond the Medicare-approved reimbursement rate for a covered service. This charge can occur when a provider does not accept assignment for Medicare patients, allowing…
Expedited Appeal
An expedited appeal is a streamlined process used to quickly resolve disputes or disagreements between a policyholder or healthcare provider and an insurance company regarding healthcare coverage decisions. Expedited appeals are typically requested when there is an urgent need for…
Explanation of Benefits (EOB)
An Explanation of Benefits (EOB) is a document sent by a health insurance company to a policyholder after a healthcare service has been provided or a claim has been processed. The EOB outlines the costs incurred for the service, the…
Extra Help
Extra Help, also known as the Low-Income Subsidy (LIS) program, is a federal program that provides financial assistance to help Medicare beneficiaries with limited income and resources afford prescription drug coverage. Eligible individuals may receive assistance with premiums, deductibles, copayments,…
Extra Help Premium Amount
Extra Help Premium Amount refers to the subsidized premium assistance provided to eligible individuals under the Medicare Part D Extra Help program. This program helps lower-income Medicare beneficiaries afford their prescription drug coverage by reducing or eliminating their Part D…
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F
Fall Open Enrollment
Fall Open Enrollment refers to a specific time frame during which individuals can enroll in or make changes to their health insurance coverage for the upcoming year. This period typically occurs annually and allows individuals to select or switch healthcare…
Federal District Court
The Federal District Court is a trial court within the federal judiciary system responsible for hearing a wide range of civil and criminal cases. Each district court has jurisdiction over specific geographic regions, known as federal districts, and handles cases…
Federal Employees Health Benefits (FEHB)
The Federal Employees Health Benefits (FEHB) program provides comprehensive health insurance coverage to federal employees, retirees, and their eligible family members. Administered by the U.S. Office of Personnel Management (OPM), FEHB offers a wide range of health plans from various…
Federal Poverty Level (FPL)
The Federal Poverty Level (FPL) is a set income threshold established by the federal government to determine eligibility for various assistance programs, such as Medicaid, the Children's Health Insurance Program (CHIP), and premium tax credits for health insurance coverage under…
Federally Qualified Health Center (FQHC)
A Federally Qualified Health Center (FQHC) is a community-based healthcare facility that receives federal funding from the Health Resources and Services Administration (HRSA) to provide comprehensive primary care services to underserved populations. FQHCs offer a wide range of medical, dental,…
Fee-for-Service
Fee-for-Service is a payment model in healthcare where providers are reimbursed based on the services they deliver to patients. Under this model, healthcare providers bill for each service rendered, and reimbursement is typically determined by a fee schedule established by…
Formulary
A formulary is a list of prescription drugs covered by a health insurance plan, typically categorized into tiers based on cost and coverage criteria. Insurance companies and pharmacy benefit managers use formularies to determine which medications are covered, and at…
Formulary Restrictions
Formulary restrictions are limitations or requirements imposed by insurance plans regarding the medications covered under their formulary, which is a list of prescription drugs approved for coverage. These restrictions may include requirements such as prior authorization, step therapy, quantity limits,…
Free Look Period
The Free Look Period is a designated time frame provided to insurance policyholders during which they can review the terms and conditions of their insurance policy, assess its coverage, and decide whether to keep or cancel the policy without penalty.…
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G
Gaps in Coverage
Gaps in coverage refer to periods during which individuals may experience a lack of health insurance or limited access to healthcare services. These gaps can occur for various reasons, such as loss of employment, changes in eligibility for public programs…
Gatekeeper
In healthcare, a gatekeeper refers to a healthcare provider, typically a primary care physician, who serves as the initial point of contact for patients seeking medical care. The gatekeeper plays a crucial role in coordinating and managing the patient's healthcare…
General Enrollment Period (GEP)
The General Enrollment Period (GEP) is a specific time frame provided by Medicare for individuals who missed their initial enrollment period to sign up for Medicare Part B or Part D coverage. The GEP typically occurs annually from January 1st…
Generic Drug
A generic drug is a medication that contains the same active ingredients as a brand-name drug and is equivalent in strength, dosage form, route of administration, quality, performance characteristics, and intended use. Generic drugs are typically sold at a lower…
Grievance
A grievance in the context of healthcare refers to a formal complaint or dissatisfaction expressed by an individual regarding the quality of care, treatment received, or coverage decisions made by a healthcare provider or insurance plan. Grievances may involve issues…
Group health plan
A group health plan is a type of health insurance plan that provides coverage to a defined group of individuals, such as employees of a company, members of a union, or members of a professional organization. Group health plans are…
Guaranteed issue rights (also called "Medigap protections")
Guaranteed issue rights, also known as "Medigap protections," are rights granted to Medicare beneficiaries that ensure they can purchase a Medicare Supplement Insurance (Medigap) plan without undergoing health screenings or being denied coverage due to pre-existing conditions. These rights are…
Guaranteed renewable policy
A guaranteed renewable policy is an insurance policy that guarantees coverage renewal at the end of each policy term, regardless of changes in the insured individual's health status or other factors. With a guaranteed renewable policy, the insurance company cannot…
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H
Health care provider
A healthcare provider is an individual or organization that delivers medical services or care to patients. This can encompass a wide range of professionals, including doctors, nurses, physician assistants, therapists, pharmacists, and other allied healthcare professionals. Healthcare providers may work…
Health Care Proxy
A Health Care Proxy is a legal document that allows an individual to appoint a trusted person, known as a healthcare proxy or agent, to make healthcare decisions on their behalf in the event that they become unable
Health Insurance Marketplace
The Health Insurance Marketplace, also known as the Health Insurance Exchange, is a platform established under the Affordable Care Act (ACA) where individuals and families can compare and purchase health insurance plans. It provides a centralized marketplace where consumers can…
Health Maintenance Organization (HMO)
A Health Maintenance Organization (HMO) is a type of managed care health insurance plan that emphasizes preventive care and coordination of healthcare services through a network of providers. HMO members typically choose a primary care physician (PCP) who manages their…
Hill-Burton Program
The Hill-Burton Program is a federal program established to improve access to healthcare services by providing funding to hospitals and other healthcare facilities. In exchange for receiving funds, participating facilities are required to provide a specified amount of free or…
Home health agency
A home health agency is a healthcare organization that delivers medical care, therapy, and support services to individuals in their own homes. These services are often provided to patients who are recovering from illness or surgery, managing chronic health conditions,…
Home Health Aide
A Home Health Aide (HHA) is a trained caregiver who provides assistance with activities of daily living to individuals in their homes. HHAs may help with tasks such as bathing, dressing, grooming, meal preparation, and light housekeeping, enabling clients to…
Home health care
Home health care is a type of healthcare service that provides medical treatment, therapy, and support services to individuals in their own homes. It is often utilized by patients who are recovering from illness, injury, or surgery, managing chronic health…
Homebound
Homebound refers to a condition in which an individual has difficulty or is unable to leave their home due to illness, injury, or disability. Homebound individuals may require assistance with daily activities such as bathing, dressing, or meal preparation and…
Homemaking Services
Homemaking services involve assistance provided to individuals with household tasks to help them maintain a safe and comfortable living environment. These services may include light housekeeping, laundry, meal preparation, grocery shopping, and running errands. Homemaking services are often utilized by…
Hospice
Hospice is a specialized type of healthcare service that focuses on providing compassionate care and support to individuals with terminal illnesses and their families. The goal of hospice care is to enhance quality of life and provide comfort and dignity…
Hospital Insurance
Hospital insurance, also known as hospitalization insurance or inpatient coverage, is a type of health insurance that provides coverage for medical expenses incurred during hospital stays. Hospital insurance typically covers services such as room and board, nursing care, diagnostic tests,…
Hospital-Issued Notice of Non-Coverage (HINN)
A Hospital-Issued Notice of Non-Coverage (HINN) is a notice provided by a hospital to a patient or their representative, informing them that a particular service or treatment may not be covered by their insurance plan. HINNs are typically issued when…
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I
Important Message from Medicare
An Important Message from Medicare is a notice given to Medicare patients during a hospital stay to inform them of their rights and protections under Medicare. This notice outlines important information, such as the patient's right to receive necessary medical…
In-Network
In-network refers to healthcare providers or facilities that have entered into agreements with insurance companies to accept specific payment rates for services rendered to patients covered by the insurance plan. Patients who visit in-network providers typically pay lower out-of-pocket costs…
Income-Related Monthly Adjustment Amount (IRMAA)
The Income-Related Monthly Adjustment Amount (IRMAA) is an additional charge imposed on Medicare beneficiaries whose income exceeds certain thresholds. IRMAA affects Part B and Part D premiums, with higher-income individuals paying higher premiums. The purpose of IRMAA is to help…
Independent reviewer
An independent reviewer, often employed by insurance companies or regulatory bodies, serves as a neutral party to assess healthcare disputes. Their role involves reviewing cases where patients and healthcare providers disagree on treatment decisions, coverage determinations, or billing issues. Independent…
Individual Policy
An individual policy is a health insurance plan purchased by an individual to provide coverage for themselves or their family members. Unlike group policies, which are typically provided by employers or organizations, individual policies are obtained directly from insurance companies…
Initial Coverage Election Period
The Initial Coverage Election Period (ICEP) is the timeframe during which individuals can enroll in a Medicare Advantage (Part C) or Medicare Prescription Drug Plan (Part D) when they first become eligible for Medicare. This period typically coincides with the…
Initial Enrollment Period (IEP)
The Initial Enrollment Period (IEP) is the first opportunity for individuals to enroll in Medicare when they become eligible. For most people, the IEP occurs when they turn 65 and lasts for seven months, beginning three months before the month…
Inpatient
Inpatient refers to a patient who has been admitted to a hospital or other healthcare facility for medical treatment that requires overnight stay or extended care. Inpatient care typically involves intensive medical supervision and treatment, such as surgery, acute medical…
Inpatient Care
Inpatient care refers to medical treatment provided to patients who have been admitted to a hospital or other healthcare facility for overnight stay or extended care. Inpatient care involves intensive medical supervision and treatment, often requiring specialized services, equipment, and…
Inpatient rehabilitation facility
An inpatient rehabilitation facility (IRF) provides specialized care and therapy to individuals recovering from severe illnesses, injuries, or surgeries. These facilities offer comprehensive programs tailored to each patient's needs, with the goal of restoring function, improving mobility, and enhancing independence.…
Integrated Care
Integrated care refers to a healthcare approach that seeks to coordinate medical, behavioral, and social services to provide comprehensive and holistic care to patients. By integrating various aspects of healthcare, including physical health, mental health, and social support, integrated care…
Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) are residential facilities that offer specialized care and services to individuals with intellectual disabilities. These facilities provide a structured environment where residents receive assistance with activities of daily living, behavioral support,…
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Language Therapy
Language therapy, also known as speech-language therapy or speech therapy, is a specialized form of therapy aimed at improving communication skills and addressing language disorders in individuals of all ages. Language therapists work with clients to assess their speech, language,…
Large group health plan
A large group health plan is a type of employer-sponsored health insurance plan that provides coverage to a significant number of employees, typically those working for large companies or organizations. These plans offer comprehensive benefits and may include medical, dental,…
Late Enrollment Penalty
The Late Enrollment Penalty is a financial consequence imposed on Medicare beneficiaries who delay enrolling in Medicare Part A, Part B, or Part D coverage without having creditable coverage elsewhere. This penalty is added to the monthly premium and may…
Lifetime reserve days
Lifetime reserve days are additional days of inpatient hospital coverage available to Medicare beneficiaries beyond their initial benefit period. Medicare Part A provides coverage for hospital stays, but once the beneficiary exhausts their regular coverage days, they may use up…
Limiting charge
A limiting charge is the highest amount that a healthcare provider who does not accept assignment from Medicare can charge a patient for a covered service. Medicare sets this limit at 15% above the Medicare-approved amount for the service. If…
Living will
A living will, also known as an advance directive, is a legal document that allows individuals to specify their preferences for medical treatment and end-of-life care in advance of incapacity. In a living will, individuals can outline their wishes regarding…
Long-term care
Long-term care encompasses a range of services and support designed to assist individuals with chronic illnesses, disabilities, or cognitive impairments in performing activities of daily living. These services may include assistance with bathing, dressing, eating, medication management, mobility, and transportation.…
Long-term care hospital
A long-term care hospital (LTCH) is a specialized healthcare facility that provides extended medical care for patients with complex medical conditions or those who require prolonged recovery periods. These hospitals offer comprehensive services, including 24-hour nursing care, physician oversight, rehabilitation…
Long-Term Care Insurance
Long-Term Care Insurance is a specialized type of insurance designed to cover the costs associated with long-term care services and supports for individuals who require assistance with activities of daily living (ADLs) due to chronic illness, disability, or cognitive impairment.…
Long-term care ombudsman
A long-term care ombudsman is a trained advocate who works to protect the rights and well-being of residents in nursing homes, assisted living facilities, and other long-term care settings. Ombudsmen serve as independent, neutral intermediaries between residents, their families, facility…
Long-Term Services and Supports (LTSS)
Long-Term Services and Supports (LTSS) encompass a variety of medical and non-medical services aimed at assisting individuals who have functional limitations or chronic conditions and require ongoing support with activities of daily living (ADLs) and instrumental activities of daily living…
Low-Income Subsidy (LIS)
Low-Income Subsidy (LIS), also known as Extra Help, is a federal program administered by Medicare that assists eligible beneficiaries with limited income and resources in affording prescription drug costs. The program helps cover expenses such as premiums, deductibles, and co-payments…
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Maintenance Care
Maintenance care refers to ongoing healthcare services provided to individuals to prevent or manage chronic conditions, promote overall wellness, and maintain optimal health outcomes. These services may include routine check-ups, screenings, vaccinations, counseling, and lifestyle management interventions. Maintenance care is…
Managed Long-Term Care (MLTC)
Managed Long-Term Care (MLTC) is a healthcare delivery model designed to provide integrated, coordinated care to individuals with chronic conditions or disabilities who require long-term care services. MLTC programs are typically administered by managed care organizations (MCOs) that contract with…
Marketing Violations
Marketing violations refer to breaches of regulations governing the promotion and sale of insurance products, with a particular focus on Medicare plans. These violations may include deceptive advertising practices, misrepresentation of plan benefits, inappropriate sales tactics, and failure to comply…
Marketplaces (also known as Exchanges)
Marketplaces, also known as Exchanges, are online platforms established under the Affordable Care Act (ACA) where individuals and small businesses can compare, select, and purchase health insurance plans. These platforms offer a variety of insurance options from different insurers, allowing…
Maximum Out-of-Pocket (MOOP)
Maximum Out-of-Pocket (MOOP) refers to the maximum amount a beneficiary is obligated to pay for covered healthcare services within a defined period under a health insurance plan. Once this limit is reached, the insurance plan typically covers all remaining eligible…
MAXIMUS
MAXIMUS is a global company that specializes in providing consulting, technology, and management services to support healthcare administration and government programs. With a focus on improving outcomes and efficiency, MAXIMUS offers solutions tailored to the needs of public sector agencies,…
Medicaid
Medicaid is a government-funded health insurance program in the United States that provides healthcare coverage to eligible low-income individuals and families. Administered by states within federal guidelines, Medicaid offers a range of services, including doctor visits, hospital stays, prescription drugs,…
Medicaid Buy-In
Medicaid Buy-In is a program designed to support individuals with disabilities who want to work and maintain Medicaid coverage. Under this program, individuals who have disabilities that might otherwise disqualify them from Medicaid due to their income or assets can…
Medicaid Spend-Down
Medicaid Spend-Down is a process that allows individuals with high medical expenses to qualify for Medicaid coverage by reducing their income to meet the program's eligibility criteria. Under Medicaid Spend-Down rules, individuals whose income exceeds the Medicaid eligibility limit can…
Medical Social Services
Medical social services are an essential component of healthcare delivery, providing support to patients and their families to address social, emotional, and environmental factors that impact health and well-being. Medical social workers and other trained professionals collaborate with healthcare teams…
Medical Supplies
Medical supplies encompass a wide range of equipment, devices, and consumable items used for medical purposes, including treatment, diagnosis, and rehabilitation. These supplies include items such as bandages, wound dressings, syringes, catheters, braces, and mobility aids, among others. Medical supplies…
Medical underwriting
Medical underwriting is a process used by insurance companies to evaluate the health risks of individuals applying for insurance coverage. During underwriting, insurers assess factors such as medical history, current health status, age, lifestyle habits, and pre-existing conditions to determine…
Medically necessary
Medically necessary services are healthcare services or treatments that are determined to be essential for diagnosing, preventing, or treating a medical condition based on accepted medical standards and clinical guidelines. These services are considered appropriate and reasonable for addressing a…
Medically Necessary
Medically necessary refers to healthcare services or procedures that are deemed essential for diagnosing, treating, or managing a patient's medical condition. These services are based on accepted standards of medical practice and are required to address the patient's health needs…
Medicare
Medicare is a federal health insurance program in the United States that provides coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities or end-stage renal disease. Administered by the Centers for Medicare & Medicaid…
Medicare Administrative Contractor (MAC)
Medicare Administrative Contractors (MACs) are entities contracted by the Centers for Medicare & Medicaid Services (CMS) to process Medicare claims and administer the Medicare program within designated geographic regions across the United States. MACs play a crucial role in ensuring…
Medicare Advantage Drug Plan
A Medicare Advantage Drug Plan, also known as Medicare Part C, is a type of Medicare health plan offered by private insurance companies approved by Medicare. These plans provide all the benefits of Original Medicare (Part A and Part B)…
Medicare Advantage Open Enrollment Period (MA OEP)
The Medicare Advantage Open Enrollment Period (MA OEP) is an annual period during which Medicare Advantage enrollees have the opportunity to make changes to their Medicare Advantage plans. This period typically occurs from January 1st through March 31st each year.…
Medicare Advantage Plan (Part C)
Medicare Advantage Plan, also known as Medicare Part C, is an alternative to traditional Medicare offered by private insurance companies approved by Medicare. Medicare Advantage plans provide all the benefits of Medicare Parts A and B, and often include additional…
Medicare Appeals Council (Council)
The Medicare Appeals Council (Council) is an independent body within the U.S. Department of Health and Human Services responsible for reviewing appeals of Medicare coverage and payment decisions made by Administrative Law Judges (ALJs) and Qualified Independent Contractors (QICs). The…
Medicare Card
A Medicare card is a government-issued identification card provided to individuals enrolled in the Medicare program. The card serves as proof of Medicare coverage and contains important information, including the beneficiary's name, Medicare number, and effective dates of coverage. Medicare…
Medicare Cost Plan
A Medicare Cost Plan is a type of Medicare health plan offered by private insurance companies that provides coverage under both Medicare Part A (hospital insurance) and Part B (medical insurance). Cost plans allow beneficiaries to receive services from Medicare-approved…
Medicare drug coverage (Part D)
Medicare drug coverage, also known as Medicare Part D, is a prescription drug benefit available to Medicare beneficiaries. Part D plans are offered by private insurance companies approved by Medicare and provide coverage for both brand-name and generic prescription drugs.…
Medicare drug plan (Part D)
A Medicare drug plan, also referred to as Medicare Part D, is a prescription drug benefit offered to Medicare beneficiaries to help cover the costs of prescription medications. These plans are provided by private insurance companies approved by Medicare and…
Medicare Fraud
Medicare fraud refers to illegal activities perpetrated with the intent to unlawfully obtain Medicare benefits or payments through deceptive practices. Common forms of Medicare fraud include billing for services or supplies that were not provided, submitting false claims for medically…
Medicare Health Maintenance Organization (HMO) Plan
A Medicare Health Maintenance Organization (HMO) Plan is a type of Medicare Advantage plan that offers comprehensive healthcare coverage to Medicare beneficiaries through a network of healthcare providers, including doctors, hospitals, and other medical facilities. HMO plans typically require beneficiaries…
Medicare health plan
A Medicare health plan is a type of healthcare coverage offered to Medicare beneficiaries that provides comprehensive coverage for medical services. These plans, also known as Medicare Advantage plans (Part C), are offered by private insurance companies approved by Medicare…
Medicare Medical Savings Account (MSA) Plan
A Medicare Medical Savings Account (MSA) Plan is a type of Medicare Advantage plan that combines a high-deductible health insurance policy with a medical savings account (MSA) that beneficiaries can use to pay for eligible healthcare expenses. These plans have…
Medicare Part A (Hospital Insurance)
Medicare Part A, also known as Hospital Insurance, is one of the two main components of the federal Medicare program. Part A provides coverage for inpatient hospital care, including semi-private room accommodation, meals, nursing services, and necessary medical supplies and…
Medicare Part B (Medical Insurance)
Medicare Part B, also known as Medical Insurance, is the second main component of the federal Medicare program. Part B provides coverage for outpatient medical services, including doctor visits, diagnostic tests, outpatient surgeries, durable medical equipment, and preventive care services…
Medicare plan
A Medicare plan refers to the healthcare coverage provided through the federal Medicare program for eligible individuals aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions. Medicare offers different parts that cover specific…
Medicare Preferred Provider Organization (PPO) Plan
A Medicare Preferred Provider Organization (PPO) Plan is a type of Medicare Advantage plan that offers comprehensive healthcare coverage to Medicare beneficiaries through a network of preferred providers, including doctors, hospitals, and other healthcare facilities. PPO plans provide flexibility for…
Medicare Prescription Drug Benefit
The Medicare Prescription Drug Benefit, also known as Medicare Part D, is a federal program designed to help Medicare beneficiaries afford prescription medications. Part D plans are offered by private insurance companies approved by Medicare, and they provide coverage for…
Medicare Private Drug Plan
A Medicare Private Drug Plan, also known as Medicare Part D, is a prescription drug plan offered by private insurance companies approved by Medicare. These plans provide coverage for prescription medications, helping Medicare beneficiaries afford the cost of their medications.…
Medicare Private Fee-For-Service (PFFS) Plan
A Medicare Private Fee-For-Service (PFFS) Plan is a type of Medicare Advantage plan that allows beneficiaries to receive healthcare services from any Medicare-approved provider who accepts the plan's payment terms and conditions. PFFS plans determine how much they will pay…
Medicare Private Health Plan
A Medicare Private Health Plan, also known as Medicare Advantage, is a type of Medicare plan offered by private insurance companies approved by Medicare. These plans provide all the benefits of Medicare Part A and Part B coverage, and often…
Medicare Savings Program
Medicare Savings Programs are state-run programs that assist eligible Medicare beneficiaries with limited income and resources in paying for their Medicare premiums, deductibles, coinsurance, and copayments. These programs, also known as Medicare Buy-In programs, are designed to provide financial assistance…
Medicare SELECT
Medicare SELECT is a type of Medicare Supplement Insurance (Medigap) plan that offers coverage for Medicare out-of-pocket costs not covered by Original Medicare, such as deductibles, coinsurance, and copayments. Medicare SELECT plans are similar to traditional Medigap plans but require…
Medicare Special Needs Plan (SNP)
A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan designed to provide specialized healthcare coverage for individuals with specific health needs or conditions, such as chronic illnesses, disabilities, or certain medical conditions. SNPs tailor their benefits,…
Medicare Summary Notice (MSN)
A Medicare Summary Notice (MSN) is a document that Medicare beneficiaries receive every three months from Medicare. It provides a summary of healthcare services and supplies that were billed to Medicare on the beneficiary's behalf, the amount Medicare paid, and…
Medicare Supplement
Medicare Supplement, also known as Medigap, refers to private insurance policies designed to complement Original Medicare coverage. These policies help pay for healthcare costs that Original Medicare does not cover, such as deductibles, copayments, and coinsurance. Medicare Supplement plans are…
Medicare-approved amount
The Medicare-approved amount refers to the maximum payment that Medicare will cover for a particular healthcare service or item. This amount is determined by Medicare and is based on the fee schedule or payment rates set by the Medicare program…
Medicare-certified provider
A Medicare-certified provider is a healthcare provider, such as a doctor, hospital, nursing home, home health agency, or other healthcare facility, that meets Medicare's standards and requirements for participation in the Medicare program. To become Medicare-certified, providers must undergo a…
Medigap
Medigap, also known as Medicare Supplement Insurance, is private health insurance designed to supplement Original Medicare (Parts A and B) by helping pay for out-of-pocket costs such as deductibles, coinsurance, and copayments. Medigap policies are sold by private insurance companies…
Medigap Open Enrollment Period
The Medigap Open Enrollment Period is a six-month period that begins when a Medicare beneficiary is both 65 years old or older and enrolled in Medicare Part B. During this period, beneficiaries have guaranteed issue rights, meaning they can enroll…
Medigap policy
A Medigap policy, also known as Medicare Supplement Insurance, is a private insurance policy designed to help cover out-of-pocket healthcare costs not covered by Original Medicare (Parts A and B). Medigap policies are sold by private insurance companies and offer…
Multi-employer plan
A multi-employer plan is a type of employee benefit plan that provides healthcare and other benefits to employees from multiple employers who are typically in the same industry or trade union. These plans are collectively bargained agreements between employers and…
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National Coverage Determination (NCD)
National Coverage Determination (NCD) refers to official policy decisions made by the Centers for Medicare & Medicaid Services (CMS) regarding the coverage of specific medical services or procedures under the Medicare program. NCDs establish whether Medicare will cover a particular…
Network
In healthcare, a network refers to a group of healthcare providers, facilities, and suppliers that have contracted with an insurance plan or managed care organization to deliver medical services to its members. Networks can include hospitals, physicians, specialists, pharmacies, laboratories,…
Non-Participating Provider
A non-participating provider is a healthcare professional or facility that has not entered into a contract with a specific insurance plan or Medicare to accept their reimbursement rates for medical services. While non-participating providers may still treat patients covered by…
Notice of Medicare Non-Coverage (NOMNC)
The Notice of Medicare Non-Coverage (NOMNC) is a formal notice sent to Medicare beneficiaries to inform them of the termination of Medicare coverage for specific healthcare services or items. This notice is typically issued by skilled nursing facilities, home health…
Nursing Home
A nursing home, also known as a skilled nursing facility (SNF) or long-term care facility, is a residential care setting that provides 24-hour skilled nursing care and assistance with activities of daily living for individuals who require long-term or rehabilitative…
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Observation Stay
An observation stay refers to a period during which a patient receives medical care and monitoring in a hospital setting without being formally admitted as an inpatient. Observation stays are typically used for patients who require additional evaluation or monitoring…
Occupational Therapy
Occupational therapy is a healthcare profession dedicated to helping individuals of all ages improve their ability to perform daily activities and tasks, including self-care, work, and leisure activities. Occupational therapists work with clients to assess their functional abilities, identify barriers…
Off-Label
Off-label refers to the use of a medication or medical device for a purpose not approved by regulatory authorities such as the Food and Drug Administration (FDA) or the European Medicines Agency (EMA). While drugs and devices are initially approved…
Opt-Out
Opt-out refers to a process by which healthcare providers choose not to participate in Medicare or Medicaid programs and instead operate on a private-pay basis, allowing them to set their own fees and billing practices. Providers who opt out of…
Original Medicare
Original Medicare refers to the healthcare coverage provided directly by the federal government to eligible individuals. It consists of two main parts: Part A, which covers hospital stays, skilled nursing facility care, hospice care, and some home health care services,…
Out-of-Network
Out-of-network refers to healthcare services received from providers who have not entered into a contract with a specific insurance plan or managed care organization. When individuals seek care from out-of-network providers, they may incur higher out-of-pocket costs compared to using…
Out-of-pocket costs
Out-of-pocket costs refer to the expenses that individuals must pay directly for healthcare services, treatments, or medications that are not covered by their insurance plans. These costs typically include deductibles, copayments, and coinsurance, as well as any expenses for services…
Out-of-Pocket Limit
The out-of-pocket limit is the maximum amount of money that an individual is obligated to pay for covered healthcare services within a specific period, typically a calendar year, under their health insurance plan. Once this limit is reached, the insurance…
Outpatient
Outpatient care refers to medical treatment or services provided to patients who do not require an overnight stay in a hospital or other healthcare facility. Patients receive care on an outpatient basis for various procedures, examinations, therapies, and consultations, returning…
Outpatient Care
Outpatient care refers to medical services provided to patients who do not require hospitalization, encompassing consultations, treatments, and procedures conducted in outpatient settings such as clinics, physician offices, and ambulatory surgery centers. Patients receiving outpatient care typically visit healthcare facilities…
Outpatient Prospective Payment System (OPPS)
The Outpatient Prospective Payment System (OPPS) is Medicare's payment methodology for reimbursing hospitals and outpatient facilities for services provided to Medicare beneficiaries on an outpatient basis. Under OPPS, Medicare pays hospitals and other providers predetermined rates for covered outpatient services…
Over-the-Counter Drug
Over-the-counter (OTC) drugs are medications that are available for purchase without a prescription from a healthcare provider. These medications are commonly used to treat minor ailments and symptoms such as headaches, colds, allergies, and mild pain. OTC drugs are widely…
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Palliative Care
Palliative Care is a specialized approach to healthcare that focuses on improving the quality of life for individuals facing serious illnesses, such as cancer, heart failure, or dementia. The goal of palliative care is to provide relief from symptoms, pain,…
Pap test
A Pap test, also known as a Pap smear, is a routine screening test used to detect cervical cancer or abnormalities in the cervix, the lower part of the uterus. During a Pap test, a healthcare provider collects a sample…
Participating Provider
A participating provider refers to a healthcare professional, such as a doctor, specialist, or facility, that has entered into a contract with a health insurance plan or network. By agreeing to participate in the plan, these providers agree to accept…
Pastoral Care
Pastoral care is a form of holistic support provided by trained clergy, chaplains, or other spiritual caregivers to individuals and families dealing with illness, grief, or other difficult situations. Rooted in religious or spiritual traditions, pastoral care focuses on offering…
Patient Assistance Program (PAP)
A Patient Assistance Program (PAP) is a resource provided by pharmaceutical companies, nonprofit organizations, or government agencies to help individuals who are unable to afford their prescription medications due to financial hardship. These programs offer assistance in the form of…
Pelvic exam
A pelvic exam is a routine medical examination performed by a healthcare provider to assess the health of a woman's reproductive organs, including the uterus, ovaries, fallopian tubes, cervix, and vagina. During a pelvic exam, the healthcare provider examines the…
Penalty
A penalty is a punishment or fine imposed on individuals or entities for violating rules, regulations, or contractual obligations. In the context of healthcare and insurance, penalties may be applied for various reasons, such as failing to enroll in health…
Personal Care
Personal care refers to the assistance provided to individuals who require help with activities of daily living (ADLs) due to aging, illness, injury, or disability. These activities may include bathing, dressing, grooming, toileting, and mobility assistance. Personal care services are…
Pharmacotherapy
Pharmacotherapy, also known as medication therapy, is the practice of using pharmaceutical agents, including prescription drugs, over-the-counter medications, and supplements, to prevent, manage, or cure medical conditions and promote overall health and well-being. Pharmacotherapy involves prescribing medications based on an…
Physical Therapy
Physical Therapy (PT) is a healthcare discipline focused on restoring, maintaining, and improving physical function and mobility through targeted exercises, manual techniques, and therapeutic modalities. PT is commonly prescribed for individuals recovering from injuries, surgeries, or illnesses, as well as…
Pilot programs
Pilot programs are experimental initiatives implemented on a small scale to test new ideas, interventions, or technologies before wider adoption or implementation. In the healthcare context, pilot programs are often used to evaluate the effectiveness, feasibility, and impact of innovative…
Plan of Care
A Plan of Care is a comprehensive document developed by healthcare professionals, such as physicians, nurses, therapists, and social workers, in collaboration with patients and their families, to guide the delivery of healthcare services and interventions. The Plan of Care…
Point-of-service option
A point-of-service (POS) option is a feature offered by some health insurance plans that provides beneficiaries with flexibility in choosing healthcare providers and services within and outside the plan's designated network. With a POS option, beneficiaries can typically receive healthcare…
Power of attorney
A power of attorney (POA) is a legal document that grants someone, known as the agent or attorney-in-fact, the authority to make decisions and act on behalf of another person, known as the principal. This authority can extend to various…
Pre-existing condition
A pre-existing condition is a health condition, illness, or injury that an individual has before obtaining health insurance coverage. Common pre-existing conditions include chronic diseases like diabetes, heart disease, asthma, or cancer, as well as previous injuries or surgeries. In…
Pre-existing Condition Waiting Period
A Pre-existing Condition Waiting Period is a specified timeframe during which individuals with pre-existing health conditions must wait before their health insurance coverage begins to cover expenses related to those conditions. This waiting period is typically imposed by insurance companies…
Preferred Pharmacy
A Preferred Pharmacy is a pharmacy that is part of a health insurance plan's network and has agreed to provide discounted prices on prescription medications to plan members. Health insurance plans, including Medicare Part D plans and commercial insurance plans,…
Preferred Provider Organization (PPO)
A Preferred Provider Organization (PPO) is a type of health insurance plan that offers individuals flexibility in selecting healthcare providers and facilities. Unlike Health Maintenance Organizations (HMOs), which typically require members to choose a primary care physician and obtain referrals…
Premium
A premium is the amount paid to an insurance company for coverage under an insurance policy, typically on a monthly basis. It represents the cost of obtaining and maintaining insurance coverage and is determined based on various factors, including the…
Premium Penalty
A Premium Penalty is an additional fee or surcharge applied to individuals who fail to enroll in health insurance coverage during designated enrollment periods, such as the annual Open Enrollment Period or Special Enrollment Periods. Insurance companies impose premium penalties…
Prescription
A Prescription is a formal written or electronic order issued by a licensed healthcare provider, such as a physician, nurse practitioner, or dentist, instructing a pharmacist to dispense a specific medication to a patient. Prescriptions typically include essential information, such…
Prescription Drug
A Prescription Drug is a medication that cannot be obtained without a valid prescription from a licensed healthcare provider. Prescription drugs are pharmaceutical products that have been deemed by regulatory authorities, such as the U.S. Food and Drug Administration (FDA),…
Prescription Drug Insurance
Prescription Drug Insurance, also known as prescription drug coverage or pharmacy benefits, is a type of health insurance that provides coverage for the cost of prescription medications. This insurance coverage helps individuals afford the expense of necessary prescription drugs, including…
Prescription Drug Plan (PDP)
A Prescription Drug Plan (PDP) is a type of insurance plan offered by private insurance companies approved by Medicare to provide coverage for prescription medications to Medicare beneficiaries. These plans can be purchased as standalone coverage to complement Original Medicare…
Preventive Care
Preventive care encompasses a range of healthcare services and interventions designed to identify and address health risks, prevent the onset of diseases, and promote overall well-being. These services include routine screenings, vaccinations, counseling on healthy lifestyle habits, and interventions to…
Preventive services
Preventive services are healthcare services, tests, screenings, and interventions designed to identify and prevent health problems before they occur or become more serious. These services are crucial for maintaining overall health and well-being, as they can help detect risk factors,…
Primary care doctor
A primary care doctor, also known as a primary care physician (PCP) or general practitioner (GP), is a healthcare provider who serves as the first point of contact for patients seeking medical care. Primary care doctors offer comprehensive and continuous…
Primary Care Provider (PCP)
A Primary Care Provider (PCP) serves as the first point of contact for individuals seeking healthcare services. They offer comprehensive medical care, including preventive services, routine screenings, diagnosis, treatment for common illnesses, and management of chronic conditions. PCPs play a…
Primary Insurance
Primary Insurance is the main health insurance plan that individuals rely on for coverage of medical expenses. It serves as the initial source of coverage, responsible for paying for eligible healthcare services and treatments before any secondary or supplemental insurance…
Prior authorization
Prior authorization is a process used by health insurance companies to determine if they will cover certain medical services, procedures, or medications before they are provided to patients. Healthcare providers must obtain approval from the insurer by submitting documentation that…
Private Duty Nursing
Private Duty Nursing entails individualized nursing care provided to patients in their homes, long-term care facilities, or other private settings. Nurses offering private duty services cater to the unique needs of each patient, delivering personalized care that may include medication…
Private Fee-for-Service (PFFS) plan
A Private Fee-for-Service (PFFS) plan is a type of Medicare Advantage plan that allows beneficiaries to receive healthcare services from any provider that accepts the plan's payment terms and conditions. With PFFS plans, individuals have the freedom to visit any…
Private Health Plan
A Private Health Plan refers to health insurance coverage offered by private companies rather than government-funded programs like Medicare or Medicaid. These plans are purchased by individuals or provided by employers as part of employee benefits packages. Private health plans…
Program of All-inclusive Care for the Elderly (PACE)
The Program of All-inclusive Care for the Elderly (PACE) is a unique healthcare program designed to provide comprehensive, coordinated care to frail seniors who are eligible for nursing home level care but prefer to live in their communities. PACE programs…
Provider
Providers are individuals or entities involved in delivering healthcare services to patients. This term encompasses a wide range of healthcare professionals, including doctors, nurses, specialists, therapists, and other licensed medical practitioners, as well as healthcare facilities such as hospitals, clinics,…
Provider-Sponsored Organization (PSO)
A Provider-Sponsored Organization (PSO) is a type of healthcare organization established and operated by healthcare providers, such as hospitals, physician groups, or healthcare systems, with the primary purpose of offering health insurance plans and services to patients. PSOs are unique…
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QIO Review
QIO Review refers to the evaluation process conducted by Quality Improvement Organizations (QIOs) to assess and improve the quality of healthcare services provided to Medicare beneficiaries. QIOs review medical records, conduct site visits, analyze data, and collaborate with healthcare providers…
Qualified Disabled Working Individual (QDWI)
Qualified Disabled Working Individual (QDWI) is a Medicare program designed to support individuals under the age of 65 with disabilities who return to work. QDWI eligibility criteria include having lost premium-free Medicare Part A coverage due to returning to work,…
Qualified Health Plan (QHP)
A Qualified Health Plan (QHP) refers to a health insurance plan certified by the Health Insurance Marketplace as meeting the requirements set forth by the Affordable Care Act (ACA). These plans provide essential health benefits, including preventive services, prescription drug…
Qualified Independent Contractor (QIC)
Qualified Independent Contractor (QIC) is an independent organization contracted by the Centers for Medicare & Medicaid Services (CMS) to conduct reviews of Medicare coverage and payment denials. QICs serve as impartial entities tasked with reviewing appeals submitted by Medicare beneficiaries…
Qualified Medicare Beneficiary (QMB)
Qualified Medicare Beneficiary (QMB) is a Medicare program designed to provide financial assistance to low-income individuals by covering Medicare premiums, deductibles, and coinsurance costs. QMB eligibility is based on income and asset criteria established by each state. Beneficiaries enrolled in…
Qualifying Individual (QI)
Qualifying Individual (QI) is a Medicare program aimed at providing financial assistance to individuals with limited income who struggle to afford Medicare Part B premiums. Eligible individuals must meet income and asset criteria set by their state of residence to…
Quality Improvement Organization (QIO)
A Quality Improvement Organization (QIO) is an independent entity contracted by the Centers for Medicare & Medicaid Services (CMS) to improve the quality of healthcare services delivered to Medicare beneficiaries. QIOs work with healthcare providers, hospitals, nursing homes, and other…
Quantity Limit
Quantity Limit refers to a restriction imposed by insurance plans on the quantity of medication that a beneficiary can receive within a specified period. Insurance companies implement quantity limits to ensure the appropriate use of medications, control costs, and prevent…
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Railroad Medicare Carrier
A Railroad Medicare Carrier is an entity responsible for administering Medicare benefits specifically for railroad workers, their dependents, and survivors. These carriers handle claims processing, enrollment, and customer service related to Medicare coverage for individuals covered under the Railroad Retirement…
Railroad Retirement Board
The Railroad Retirement Board (RRB) is an independent agency in the United States government responsible for administering retirement, disability, unemployment, and survivor benefits for railroad workers and their families. Established under the Railroad Retirement Act, the RRB ensures that eligible…
Reconsideration
Reconsideration is a formal process available to Medicare beneficiaries who disagree with coverage denials, claim decisions, or payment determinations made by Medicare Advantage plans, Part D prescription drug plans, or other Medicare contractors. During the reconsideration process, an independent reviewer,…
Red, White, and Blue Card
The Red, White, and Blue Card, commonly known as the Medicare card, serves as proof of Medicare eligibility for beneficiaries in the United States. It features the beneficiary's name, Medicare number, and other essential information. With this card, beneficiaries can…
Redetermination
Redetermination is a critical step in the Medicare appeals process that allows beneficiaries to challenge coverage decisions made by Medicare Advantage plans, Part D prescription drug plans, or other Medicare contractors. Through redetermination, beneficiaries can request a review of coverage…
Referral
A referral in healthcare occurs when a primary care physician or another healthcare provider recommends that a patient seek additional medical services or see a specialist for further evaluation or treatment of a specific health concern. Referrals are typically made…
Rehabilitation services
Rehabilitation services refer to a broad spectrum of medical and therapeutic interventions designed to help individuals recover physical, cognitive, or emotional function following illness, injury, or surgery. These services may include physical therapy, occupational therapy, speech therapy, and other specialized…
Rehabilitation Therapy
Rehabilitation Therapy encompasses a range of treatments and interventions designed to help individuals recover from injuries, surgeries, illnesses, or disabilities and regain independence in daily activities. This form of therapy may include physical therapy, occupational therapy, and speech-language therapy, tailored…
Religious nonmedical health care institution
A religious nonmedical health care institution is a facility or organization that offers spiritual support, counseling, and nonmedical services to individuals based on religious beliefs and practices. These institutions may provide a range of services, such as prayer, pastoral care,…
Reserve Days
Reserve Days in Medicare are extra hospitalization days provided to beneficiaries beyond their initial coverage period. Under Medicare Part A, beneficiaries are entitled to a set number of days of inpatient hospital care each benefit period. Once these days are…
Respite care
Respite care provides temporary relief and support to caregivers who are caring for individuals with chronic illnesses, disabilities, or special needs. This type of care allows caregivers to take a break from their caregiving responsibilities while ensuring that their loved…
Retiree Insurance
Retiree Insurance, also known as retiree health benefits, is healthcare coverage offered by employers to their retired employees as part of retirement benefits. This coverage may include medical, dental, vision, and prescription drug benefits, providing retirees with continued access to…
Retroactive Disenrollment
Retroactive disenrollment is a feature of Medicare that permits beneficiaries to terminate their enrollment in a Medicare Advantage plan or Part D prescription drug plan with coverage retroactively effective from a prior date. This option offers flexibility for beneficiaries who…
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Secondary Insurance
Secondary Insurance, also known as supplemental insurance or secondary coverage, offers additional coverage beyond what is provided by primary insurance. While primary insurance typically covers a portion of healthcare expenses, secondary insurance steps in to help pay for costs that…
Secondary payer
A secondary payer in healthcare refers to an insurance plan or program that covers medical costs after the primary insurance has made its payments. This typically occurs when an individual has more than one insurance plan, such as Medicare and…
Service area
A service area in healthcare refers to the geographical region where a healthcare provider, such as a hospital, clinic, or health insurance plan, offers its services and coverage. The service area determines the locations where individuals can access healthcare facilities…
Skilled Care
Skilled Care encompasses medical services delivered by trained healthcare professionals, including registered nurses, physical therapists, occupational therapists, and speech-language pathologists, among others. These professionals possess specialized training and expertise to provide advanced care and treatment for individuals with complex health…
Skilled nursing care
Skilled nursing care refers to specialized medical services provided by trained healthcare professionals, such as registered nurses (RNs) or licensed practical nurses (LPNs), to individuals with complex medical needs. This type of care is typically delivered in a skilled nursing…
Skilled nursing facility (SNF)
A skilled nursing facility (SNF) is a healthcare institution that offers specialized medical care and rehabilitation services to individuals with complex medical needs. SNFs are staffed with trained healthcare professionals, including registered nurses (RNs), licensed practical nurses (LPNs), and certified…
Skilled nursing facility (SNF) care
Skilled nursing facility (SNF) care refers to the specialized medical services and rehabilitation provided to individuals residing in skilled nursing facilities. SNF care is tailored to meet the complex healthcare needs of individuals who require ongoing nursing care, medical supervision,…
Skilled Nursing Services
Skilled Nursing Services encompass specialized medical care delivered by trained nurses to individuals with acute or chronic health conditions. These services are provided under the supervision of a physician and may include wound care, medication administration, intravenous therapy, and rehabilitation.…
Skilled Therapy Services
Skilled Therapy Services comprise therapeutic interventions provided by licensed therapists, including physical therapists, occupational therapists, and speech-language pathologists. These services are designed to address functional limitations, mobility issues, communication difficulties, and other impairments that impact an individual's daily activities and…
Social Security Administration (SSA)
The Social Security Administration (SSA) is a federal agency responsible for administering various Social Security programs aimed at providing financial assistance to eligible individuals and their families. SSA oversees programs such as retirement benefits, disability benefits, survivor benefits, and Supplemental…
Social Security Credits
Social Security Credits, also known as quarters of coverage, are earned by individuals through payment of Social Security taxes on their income. These credits play a crucial role in determining eligibility for various Social Security benefits, including retirement, disability, and…
Social Security Disability Insurance (SSDI)
Social Security Disability Insurance (SSDI) is a federal program designed to provide financial support to individuals with disabilities who are unable to work due to their impairment. To qualify for SSDI benefits, individuals must have a significant work history and…
Special Election Period
A Special Election Period (SEP) is a designated timeframe during which Medicare beneficiaries have the opportunity to make changes to their Medicare Advantage (Part C) or Medicare prescription drug coverage (Part D) outside of the standard enrollment periods. Eligible individuals…
Special Enrollment Period (SEP)
Special Enrollment Period (SEP) is a designated timeframe that allows individuals to enroll in or make changes to their Medicare coverage outside of the standard enrollment periods. Eligible individuals may qualify for an SEP due to specific life events, such…
Special Needs Plan (SNP)
Special Needs Plan (SNP) is a specialized type of Medicare Advantage plan designed to meet the unique healthcare needs of individuals with specific chronic conditions, disabilities, or other qualifying characteristics. SNPs offer comprehensive benefits and care coordination services tailored to…
Specialist
A Specialist is a healthcare provider who possesses advanced training and expertise in a particular field of medicine or healthcare. Unlike primary care physicians, who offer general medical services, specialists focus on specific health conditions, organs, or systems. Examples of…
Specified Low-Income Medicare Beneficiary (SLMB)
Specified Low-Income Medicare Beneficiary (SLMB) is a program under the Medicare system designed to assist individuals with limited income and resources in paying their Medicare Part B premiums. Eligible beneficiaries must meet specific income criteria set by the program, and…
Speech Therapy
Speech Therapy, also known as speech-language therapy or speech pathology, is a specialized field focused on diagnosing and treating communication disorders. Speech therapists, or speech-language pathologists (SLPs), work with individuals of all ages who experience difficulties with speech sounds, language…
Speech-Language Pathology
Speech-Language Pathology is a field dedicated to diagnosing and treating communication and swallowing disorders. Speech-language pathologists (SLPs) work with people of all ages, from infants to the elderly, who experience difficulties with speech, language, voice, or swallowing. They assess individuals'…
State Health Insurance Assistance Program (SHIP)
The State Health Insurance Assistance Program (SHIP) is a nationwide program that provides free, unbiased counseling and assistance to Medicare beneficiaries and their families. SHIP counselors offer personalized guidance on Medicare benefits, coverage options, enrollment, and claims, helping individuals make…
State Insurance Department
The State Insurance Department, also known as the Department of Insurance or Insurance Commissioner's Office, is a state-level regulatory agency responsible for overseeing insurance companies and protecting consumers in the insurance marketplace. The department regulates insurance rates, policies, and practices…
State Medical Assistance (Medicaid) office
The State Medical Assistance (Medicaid) office is a state-level agency responsible for administering the Medicaid program, a joint federal and state health insurance program that provides coverage to low-income individuals and families. The Medicaid office determines eligibility for Medicaid benefits,…
State Pharmaceutical Assistance Program (SPAP)
The State Pharmaceutical Assistance Program (SPAP) is a state-run program that provides financial assistance for prescription drugs to eligible individuals, particularly those with low incomes or high medication costs. SPAPs vary by state but typically offer discounts, subsidies, or coverage…
State Survey Agency
The State Survey Agency is a state-level regulatory agency responsible for overseeing compliance with federal and state regulations in healthcare facilities, such as hospitals, nursing homes, and home health agencies. The agency conducts regular inspections, surveys, and investigations to assess…
Step therapy
Step therapy, also known as "fail-first" or "step-edit" therapy, is a utilization management strategy used by health insurers to control costs and promote the use of cost-effective treatments. In step therapy, patients are required to try lower-cost or generic medications…
Supplemental Security Income (SSI)
Supplemental Security Income (SSI) is a federal assistance program administered by the Social Security Administration (SSA) that provides monthly cash benefits to disabled, blind, or elderly individuals with limited income and resources. SSI benefits are intended to help recipients meet…
Supplier
A supplier in the healthcare industry refers to a company or entity that provides goods or services to healthcare providers, facilities, or patients. Suppliers play a critical role in ensuring access to essential medical products, equipment, and services needed for…
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Take Assignment
"Take Assignment" in healthcare denotes an agreement between a healthcare provider and Medicare, where the provider accepts the Medicare-approved amount as the full payment for covered services. By accepting assignment, the provider agrees not to bill the patient for any…
Telemedicine
Telemedicine refers to the practice of providing healthcare services remotely, using telecommunications technology such as video conferencing, mobile apps, and telephones. Through telemedicine, healthcare professionals can conduct virtual consultations, diagnose medical conditions, prescribe medications, and offer treatment plans to patients…
Terminal Illness
Terminal illness refers to a disease or medical condition that is incurable and is expected to result in the patient's death within a relatively short period. Patients diagnosed with a terminal illness typically have a prognosis indicating a limited lifespan,…
Tiering Exception
A Tiering Exception is a process in healthcare where patients can request coverage for a medication listed in a higher tier of their insurance plan's formulary at a lower cost. Typically, insurance plans categorize medications into tiers based on cost…
Tiers
Tiers in healthcare and insurance plans categorize prescription drugs based on their cost and coverage level. Typically, drugs are placed into different tiers, with each tier representing a different level of cost sharing between the patient and the insurance provider.…
Transition Refill
Transition Refill refers to a temporary provision that allows individuals to obtain prescription medications during a period of transition, such as changing healthcare coverage or pharmacy networks. This temporary supply ensures continuity of care for patients who may experience interruptions…
TRICARE
TRICARE is a healthcare program administered by the United States Department of Defense that offers comprehensive health coverage to military service members, veterans, and their families. TRICARE provides access to a wide range of medical services, including preventive care, hospital…
TRICARE for Life (TFL)
TRICARE for Life (TFL) is a supplemental healthcare program designed to complement Medicare coverage for military retirees and their eligible family members who are age 65 or older. TFL provides coverage for Medicare-eligible beneficiaries, including hospital services, doctor visits, prescription…
TTY
TTY, short for teletypewriter, is a communication device used by individuals with hearing or speech impairments to communicate over telephone lines. Also known as a TDD (telecommunications device for the deaf), TTY enables users to type messages that are converted…
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Unearned Income
Unearned Income refers to funds acquired without engaging in direct labor or services. This income category encompasses various sources, including interest earnings, dividends from investments, rental income from properties, pensions, and government benefits like Social Security or unemployment compensation. Unlike…
Unskilled Care
Unskilled Care refers to basic assistance provided to individuals who require help with routine daily activities due to physical or cognitive limitations. This type of care typically involves tasks such as bathing, grooming, dressing, meal preparation, and light housekeeping. Unlike…
Urgent Care
Urgent Care refers to medical facilities that offer immediate attention to individuals with non-life-threatening injuries or illnesses, requiring prompt treatment but not necessarily emergency care. These facilities bridge the gap between primary care physicians and emergency rooms, providing services like…
Urgently needed care
Urgently needed care refers to medical attention required promptly for acute health issues or injuries that are not life-threatening but need immediate attention. This type of care typically addresses concerns that cannot wait for a scheduled appointment with a primary…
Utilization Management Tools
Utilization Management Tools encompass a variety of strategies and techniques employed by healthcare organizations to ensure efficient use of resources while maintaining quality care delivery. These tools are designed to evaluate and manage the utilization of healthcare services, including procedures,…
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Veterans Affairs (VA) Benefits
Veterans Affairs (VA) Benefits encompass a range of services and support programs offered by the U.S. Department of Veterans Affairs to veterans, their dependents, and survivors. These benefits include healthcare coverage through VA medical centers and clinics, disability compensation for…
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Waiver of Liability
A Waiver of Liability is a legal document used to release one party from any legal responsibility for potential harm, injury, or loss incurred by another party during a specific activity or event. By signing a waiver, individuals acknowledge and…
Workers' compensation
Workers' compensation is a system designed to provide financial and medical benefits to employees who suffer work-related injuries or illnesses. It is a form of insurance that employers are required to carry to protect their employees. When an employee is…
