Status (federal classification) defined by the Tax Equity and Fiscal Responsibility Act (TEFRA) that lets a federally qualified health maintenance organization (HMO) or a competitive medical plan (CMP) participate in specific Medicare cost and risk contracts and also receive federal grants and loans. A managed care organization must be a federally qualified or state plan defined to participate in the Medicaid managed care program.

Official daily publication of the federal government that is available online via the Internet. An important function of the Federal Register is its inclusion of proposed changes (e.g., final rules, legal notices and regulations, mandated standards, documents that have general applicability and legal effect) from all federal agencies, as well as executive orders and other presidential documents. HCPCS Level II and ICD-9-CM code standards appear online updated annually for the Medicare program.

1. Facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general supervision of a physician. 2. Health center that has been approved by the government for a program to give low-cost health care. Medicare pays for some health services in FQHCs that are not usually covered such as preventive care. FQHCs include community health centers, tribal health clinics, migrant health services, and health centers for the homeless. Also called federally qualified health clinic (FQHC) .

Health maintenance organization that applies and meets the requirements of the Centers for Medicare and Medicaid Services (CMS) guidelines for Medicare reimbursement as set forth in the Health Maintenance Organization Act of 1973. Staff, group, and independent practice association (IPA) model HMOs are eligible for federal qualification under the federal HMO law. Network model HMOs are usually not eligible for qualification. FQHMOs are eligible for selection by a company of more than 25 employees and the company must offer two types (i.e., one IPA and one group or staff model HMO). This is known as the “dual choice mandate” of the HMO law. FQHMOs are eligible to contract with Medicare to be reimbursed on a per capita basis for an amount equal to 95% of its estimated cost for total health care services to that person during the year.

Dollar amount for professional services rendered to a patient by a provider.

Communication of medical charges with a patient by a provider or office manager before medical services and treatment are rendered.