Estimated average cost of Medicare benefits in a given region for an individual. It is based on criteria such as age, sex, institutional status, Medicaid, disability, and end-stage renal disease (ESRD) status. Centers for Medicare and Medicaid Services (CMS) uses AAPCC as a basis for making monthly payments to managed care plans.
Tag: RAW
Adjusted CETV
The cash equivalent transfer value, worked out in the prescribed manner (the Welfare Reform and Pensions Act 1999), to establish a member’s pensions rights on divorce. The CETV is a lump sum value in current terms of the rights accrued within a member’s pension scheme.
Adjusted clinical groups (ACGs)
System developed by Johns Hopkins University that is a comprehensive family of measurement tools designed to help explain and predict how health care resources are delivered and consumed. ACGs are based on building blocks called aggregated diagnosis groups (ADGs). See aggregated diagnosis groups (ADGs).
Adjusted community rate (ACR)
Annual calculation of premium (payment rates) that health plans would have received for their Medicare enrollees to provide Medicare-covered benefits if paid their private market premiums. This is done to adjust subsequent year supplemental benefits or premiums to return any excess Medicare revenue above the ACR to enrollees. Also called average community rate (ACR). See adjusted average per capita cost (AAPCC).
Adjusted community rating (ACR)
Used by managed care plans to determine group rates for each group’s expected use of medical services during an upcoming contract period. Also known as factored rating or community rating by class (CRC).
Adjusted drug benefit list
Schedule showing names of a small amount of drugs often prescribed to long-term patients that can be modified from time to time by the managed care or insurance plan. Also called a drug maintenance list.
Adjusted gross charges
1. Accounts receivable amount showing the write-off portion from the total gross charges of amounts that by law or provider contract cannot be collected. 2. Medicare approved amount is the adjusted gross charge.
Adjusted Gross Estate
The total value of an estate at the death of the owner less an allowance for settling the estate (funeral expenses, administrative costs, etc.
Adjusted historical payment basis (AHPB)
Average payment for the service in a locality under the current system. AHPB is based on the average prevailing charge Medicare paid all physicians in a particular geographic area for a specific service. “Adjusted” means reduced by a percent to ensure that the fee schedule phase-in is budget neutral. Medicare carriers used ADPBs to figure blended payment rates during the transition period before implementation of the RBRVS system of payment.
Adjusted indemnity limit
The initial indemnity limit under a reinsurance contract minus the losses paid during the current contract period. It is the amount of cover remaining unless reinstatement applies.