Enacted July 1, 1988, this law provided the most significant expansion of the Medicare program since its inception. It also contained numerous technical amendments to the Medicare and Medicaid programs, as well as three new Medicaid provisions. However, in December 1989, the President signed into law Public Law 101-234, which repealed the major expansions of the Medicare program enacted the previous year.

Computer software program used by Medicare fiscal intermediaries that identifies code inconsistencies in data on inpatient insurance claims. The MCE evaluates the coverage, codes, and clinical information and screens for accuracy and consistency such as the patient’s age, sex, discharge status, DRG payment, principal and secondary diagnoses, and procedures.

Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003 was passed by Congress in which Section 911 required the Centers for Medicare and Medicaid Services (CMS) to replace the fiscal intermediary and carrier contracts for the administration of Medicare benefits with Medicare administrative contractors (MACs). Its intention is to improve Medicare’s administrative services to beneficiaries and health care providers and to bring standard contracting principles to Medicare (i.e., competition and performance incentives). In this reform, the United States will be divided into 15 A/B jurisdictions and each A/B jurisdiction will be assigned to one MAC who administers both Part A and Part B claims. Also see Medicare administrative contractor (MAC) and A/B jurisdictions .

Medicare contractor who collects and manages information on other types of insurance or coverage that pay before Medicare. Some examples of other types of insurance or coverage are group health coverage, retiree coverage, workers’ compensation, no-fault or liability insurance, veterans’ benefits, TRICARE, Federal Black Lung Program, and COBRA. Also see coordination of benefits (COB) .

Type of health maintenance organization (HMO). If the patient receives medical services outside of the plan’s network without a referral, the Medicare-covered services will be paid for under the Original Medicare Plan, except the patient’s plan pays for emergency services, or urgently needed services outside the service area.

Medical benefits composed of two parts: hospital insurance (Part A) and medical insurance (Part B). See Medicare Part A and Medicare Part B .

Committee that informs the Centers for Medicare and Medicaid Services (CMS) on whether specific medical items and services are reasonable and necessary under Medicare law. They perform this task via a careful review and discussion of specific clinical and scientific issues in an open and public forum. The MCAC is advisory in nature, with the final decision on all issues resting with CMS. The advice given by the MCAC is most useful when it results from a process of full scientific inquiry and thoughtful discussion, in an open forum, with careful framing of recommendations and clear identification of the basis of those suggestions. MCAC supplements CMS’s internal expertise and ensures an unbiased and contemporary consideration of state-of-the-art technology and science. MCAC members are valued for their background, education, and expertise in a wide variety of scientific, clinical, and other related fields. In composing the MCAC, CMS was diligent in pursuing ethnic, gender, geographical, and other diverse views and in carefully screening each member to determine potential conflicts of interest.

Regional insurance carrier that has entered into an agreement with the Centers for Medicare and Medicaid Services (CMS) to administer durable medical equipment for a region.