Medicare Learning Center
The Medicare Learning Center and MedicareHMO newsletter, brought to you by MCOL, have been developed to provide a resource for health care professionals for business information on Medicare health plans and related programs including Medicare Advantage and Part D Presecription Drug Plans.
| Term | Definition |
|---|---|
| Independent Payment Advisory Board (IPAB) | Provided for under the Affordable Care Act, the Board has the authority to issue recommendations to reduce the growth in Medicare spending, and provides the Board’s recommendations to be considered by Congress and implemented by the Administration on a fast-track basis. |
| Intermediaries | Insurance organizations that contract with CMS to process Medicare claims. |
| IPAB | See Independent Payment Advisory Board |
| M+C | See Medicare+Choice |
| Managed Care | A type of health care delivery that emphasizes active coordination and arrangement of health services. Managed care usually involves three key components: oversight of the medical care given; contractual relationships with and organization of the providers giving care; and the covered benefits tied to managed care regulations. |
| Meaningful Use | Meaningful Use of Electronic Health Records involves a regulatory standard by which EHRs must qualify in order for applicable providers to receive government funding when purchasing a system, or avoid Medicare reductions in provider reimbursement starting on 2015. |
| Medicare | The federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD). |
| Medicare Administrative Contractor | A Medicare Administrative Contractor is a company that processes claims for Medicare. Medicare Contracting Reform is a major component in achieving health care security for beneficiaries. Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 mandates that the Secretary for Health & Human Services replace the current contracting authority to administer the Medicare Part A and Part B FFS programs, with the new Medicare Administrative Contactor authority. |
| Medicare Advantage | The program that replaced the M+Choice program under Medicare Part C. Similar to M+Choice, Medicare Advantage offers Medicare beneficiaries the option of enrolling in a health plan to receive their Medicare benefits, although the Medicare Advantage program offers additional health plan options at the regional and local levels. Medicare Advantage plans must cover all Medicare benefits under Parts A and B, and may offer supplemental benefits. |
| Medicare Advantage EHR Incentive Program | The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. Under the Medicare Advantage EHR Incentive Program, payments are made only to Medicare Advantage organizations that are licensed as HMOs, or in the same manner as HMOs, by a state. These Medicare Advantage organizations may receive incentive payments by way of Medicare Advantage affiliated hospitals (MA-affiliated hospitals) and Medicare Advantage eligible professionals. |
| Medicare Advantage Plan | A health plan contracting with CMS to provide Medicare benefits to participating enrollees under the Medicare Advantage program |
| Medicare Advantage Prescription Drug Plan | Medicare Advantage plans that include Part D prescription drug coverage |
| Medicare Advantage Quality Bonus Payment Demonstration | CMS in November 2010 announced that it would use an alternative method for computing quality bonuses. Under its broad authority to create and fund demonstration projects, CMS has set up a Medicare Advantage Quality Bonus Payment Demonstration project. In this demonstration, plans with as few as three stars (average performance) may qualify for bonus payments. Increases will vary based on the number of stars received from 3 percent for those with three stars to 5 percent for those with five stars. The project will run from 2012 to 2014. CMS estimates it will increase Medicare spending by $6.7 billion over three years, with the funds to come from the Medicare trust fund. |
| Medicare Carrier | A private company that contracts with Medicare to pay Part B bills. |
| Medicare Contractor | A Medicare Part A Fiscal Intermediary, a Medicare Part B Carrier, or a Medicare Durable Medical Equipment Regional Carrier (DMERC) |
