Department of Health and Human Services; responsible for the administration of the medicare program.
Quality Improvement Organizations; formerly known as PROs; organization that performs medical peer review of Medicare and Medicaid claims
Health Insurance Portability and Accountability Act of 1996; health coverage portability, health information privacy, administrative simplification, medical savings accounts, long-term care insurance
Electronic transactions and code sets standard requirements, privacy, security and national identifier requirements
The movement of electronic data between two entities and the technology that supports the transfer
Official publication for all presidential documents, rules and regulations, proposed rules and notices. Hospital facilities - October edition. Outpatient facilities - November or December edition
Resource Based Relative Value Scale; decrease medicare expenditures, redistribute physicians' payments more equally, and ensure quality health care.
Physician Fee Schedule
Updated April 15; RVUs for each service, geographic adjustment factor and national conversion factor
The intentional deception or misrepresentation that an individual knows to be false and makes it knowing that it could result in some unauthorized benefit to himself
Unknowingly or unintentionally submitted an inaccurate claim; generally results from unsound medical, business, or fiscal practices
Office of the Inspector General; responsible for developing an annual work plan that outlines the ways in which the medicare program is monitored to identify fraud and abuse
The means to control access and protect information from accidental or intentional disclosure to unauthorized persons and from unauthorized alteration, destruction, or loss.
Managed Care Organization; responsible for the health care serviced offered to an enrolled group or person
Preferred Provider Organization; a group of providers who form a network and who have agreed to provide services to enrollees at a discounted rate.