Program to assist in the reduction of Medicare prospective payment system (PPS) inpatient hospital reimbursement mistakes.

Minimum number of days that must pass before a Medicare administrative contractor can pay an insurance claim. Payment for manual claims is within 4 to 12 weeks and as little as 7 days when transmitted electronically. Prompt payment guidelines for clean claims transmitted by participating providers may be paid faster than for those submitted by nonparticipating providers.

Under Medicare guidelines, the amount that the provider must accept because of a contract or amount the provider voluntarily accepts as reimbursement in full from the insurer, meaning the patient’s obligation has been met.

One of the many geographical pricing areas used by Medicare administrative contractors (MACs) to calculate physicians’ customary and prevailing charges for payment. Localities are the basis for fee schedule payment areas and geographic adjustment factor (GAF) adjustments under the Medicare fee schedule (MFS).

System wherein the insured pays insurance premiums either monthly, quarterly, semiannually, or annually.

1. Dollar amount to be paid to a provider for medical services given to a member of a managed care plan. 2. Total payment that a hospital or community mental health center gets when it provides outpatient services to Medicare patients. Also see average payment rate (APR).

Activities to prevent and recover inappropriate Medicare benefit payments including Medicare Secondary Payer (MSP), medical review/utilization review (MR/UR), provider audits, and fraud and abuse detection.