Type of insurance that pays a certain cash amount for each day that the patient is in the hospital up to a specific number of days without taking into account the actual expense of the confinement. Some policies may provide higher benefit amounts if the insured is in an intensive or cardiac care unit. Indemnity insurance does not fill gaps in the Medicare coverage. Also called hospital confinement insurance .

Another name for “hospital market basket.” See hospital market basket .

1. See hospital indemnity insurance . 2. Medicare Part A under Title XVIII of the Social Security Act, in which coverage is generally provided automatically, and free of premiums, to (a) persons age 65 or older who are eligible for Social Security or Railroad Retirement benefits, whether they have claimed the monthly cash benefits or not, and (b) certain government employees and certain disabled individuals. This program provides basic protection against the costs of inpatient hospital services, posthospital skilled nursing care, home health services, and hospice care.

Trust fund that has as its primary source of income payroll taxes paid by employees and employers. This fund finances hospital and medical services covered under Medicare Part A.

Cost of the mix of goods and services (including personnel costs but excluding nonoperating costs) comprising routine, ancillary, and special care unit inpatient hospital services. Also referred to as market basket .

Inpatient services besides daily room and board charges and general nursing services that are given during a hospital stay (e.g., laboratory tests, drugs, x-ray studies).

Number given to each member hospital facility by the managed care plan or insurance company for identification purposes.

Established by Centers for Medicare and Medicaid Services (CMS) to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The national error rate is calculated using a combination of data from the CERT contractor and HPMP with each component representing about 60% and 40% of the total Medicare FFS dollars paid. The CERT program measures the error rate for claims submitted to carriers, durable medical equipment regional carriers (DMERCs), and fiscal intermediaries (FIs). The HPMP measures the error rate for the quality improvement organizations (QIOs). Beginning in 2003, CMS elected to calculate a provider compliance error rate in addition to the paid claims error rate. The provider compliance error rate measures how well providers prepare Medicare FFS claims for submission. CMS calculates the Medicare FFS error rate and estimate of improper claim payments using a methodology the Office of the Inspector General approved. The CERT methodology includes randomly selecting a sample of approximately 120,000 submitted claims, requesting medical records from providers who submitted the claims, and reviewing the claims and medical records for compliance with Medicare coverage, coding, and billing rules.

Payment to a facility for the health services given to treat an inpatient.