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.

Table used by the Centers for Medicare and Medicaid Services (CMS) to update the annual physician fee schedule to set limits for payment. This index considers annual changes in the economy taking into account inflation, productivity, and changes in health care expense factors such as malpractice insurance, personnel salaries, rent, and other expenses.

List of Medicare payment fees based on resource-based relative value scale (RBRVS) factors. These factors are based on the physician’s work, medical practice expense, and malpractice insurance costs. The fee schedule is based on relative value units (RVUs). A formula is used to obtain the RVU consisting of three components: relative value unit (RVU) for the service, a geographical adjustment factor (GAF), and a monetary conversion factor (CF). Synonymous with and also see resource-based relative value scale (RBRVS) . Also called Medicare physician’s fee schedule (MPFS) .

Publication that is given to all Medicare beneficiaries when first enrolled in the program. It provides information about how to file an insurance claim and what type of care is covered under the program.

Medicare advantage plan (e.g., HMO, PPO, or private fee-for-service plan) or other plan such as a Medicare cost plan. Everyone who has Medicare Part A and Part B is eligible for a plan in their area, except those who have end-stage renal disease (unless certain exceptions apply).

Insurance card issued to the beneficiary of the Medicare government program (see Figure M-1 ). It includes the patient’s name, insurance claim number, type of hospital and medical coverage (Part A and/or B), and effective date. The insurance claim number is the Social Security number of the wage earner with an alpha suffix. Medicare health insurance identification card.

Plan that permits Medicare to contract with other entities to examine the activities of providers, audit cost reports, educate providers, and maintain a list of authorized durable medical equipment.