Centers for Medicare and Medicaid Services (CMS) program for health plans that participate in Medicare+Choice. This program features medical care quality measurement, reporting, and improvement requirements to improve health and satisfy Medicare and Medicaid recipients.

Process to determine the quality of medical care, develop and monitor a standard of quality, introduce improvements, and maintain a desired level of excellence. Also referred to as quality program, performance improvement program , or performance management program .

Evaluation of health care services that meet established professional standards and judgments of value to the patient.

1. Measure of the best possible energy that endows a person with the power to cope successfully with the full range of challenges faced in the real world such as personal security, degree of independence, and self-sufficient decision-making. 2. Individual’s expressed satisfaction with the current life situation.

Group of practicing physicians and other health care practitioners who are under contract to the federal government to review medical care given to Medicare patients enrolled as members in managed care plans (e.g., health maintenance organizations [HMOs] and competitive medical plans [CMPs]).

Measuring the presence or absence and amount of.

Referring to a test that determines the amount or percentage of an agent that is present within the body.

Phrase related to prescription drug insurance plans indicating restriction of the amount of medication for which the Medicare beneficiary can obtain benefits during a specific period of time (most often set on a monthly basis).

Request from an insurance company for additional information about a patient.