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.

Aged individuals who have supplemental insurance coverage with complementary benefits by employment plans after retirement. In some cases, coverage may be paid by a former employer after retirement. For working-aged individuals who have group health insurance through their employer or the employment of their spouse, usually Medicare is the secondary payer (MSP). Usually crossover insurance claims processing relationships exist with many insurance carriers who insure Medicare beneficiaries.

Refers to an individual who receives medical and/or disability benefits from both Medicare and Medicaid programs. Sometimes referred to as a Care/Caid or Medi-Medi case. This term is no longer used and has been replaced by dual eligible. See dual eligible .

Drug history during the admission/encounter of the patient in the hospital.