Type of Medigap (supplemental) health insurance policy that may require a member to use hospitals and, in some cases, doctors within its network to be eligible for full benefits. Emergency care may be sought outside the preferred provider network.

Document received by the patient explaining amount charged, Medicare approval, deductible, and coinsurance for medical services rendered. See also remittance advice, Explanation of Medicare Benefits (EOMB) , and Medicare Benefits Notice (MBN) .

Informative messages issued by the Centers for Medicare and Medicaid Services (CMS) to update program policies and procedures; formerly called Medicare program memorandums .

Treasury accounts established by the Social Security Act for the receipt of revenues, maintenance of reserves, and disbursement of payments for the health insurance and supplemental medical insurance programs.

Percentage figure that represents an acceptable rate of increase in physicians’ Medicare reimbursement for 1 year. MVPS is based on inflation, mix, and age of Medicare population, technological changes, improper utilization, and inadequate access to care. The Department of Health and Human Services uses a formula to establish the annual Medicare Part B increase in physicians’ payments.

Dollar amount a physician or supplier can be paid including what Medicare pays and any deductible, coinsurance, or copayment that the patient pays. It may be less than the actual amount charged by a doctor or supplier. Sometimes called approved charge or allowed amount .

Physician, other individual, or entity meeting certain quality standards that provides outpatient self-management training services and other Medicare-covered items and services.