Glossary

The First Responder uses a limited amount of equipment to perform initial assessment and intervention and is trained to assist other Emergency Medical Services (EMS)providers. Example: At the scene of a cardiac arrest, the First Responder would be expected to notify EMS (if not already notified) and initiate CPR with an oral airway and a barrier device.

A private company that has a contract with Medicare to pay Part A and some Part B bills. (Also called "Intermediary.")

For Medicare, a year-long period that runs from October 1st through September 30th of the next year. The government and some insurance companies follow a budget that is planned for a fiscal year.

The net worth of facilities and other resources.

This term usually refers to a file that consists of a series of fixed-length records that include some sort of record type code.

State required studies that examine a specific aspect of health care (such as prenatal care) for a defined point in time. These projects are usually based on information extracted from medical records or MCO/PHP administrative data such as enrollment files and encounter /claims data. State staff, EQRO staff, MCO/PHP staff or more than one of these entities may perform such studies at the discretion of the State.

Under HIPAA, this is those data elements that provide or control the enveloping or hierarchical structure, or assist in identifying data content of, a transaction.

A list of certain drugs and their proper dosages. In some Medicare health plans, doctors must order or use only drugs listed on the health plan's formulary.

Listing of prescription medications which are approved for use and/or coverage by the plan andwhich will be dispensed through participating pharmacies to covered enrollees.

The intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s).