Glossary

A plan is paid for providing services to enrollees through a combination of capitation and fee for service reimbursements.

A structured program of active treatment for psychiatric care that is more intense than the care you get in your doctor’s or therapist’s office.

A stipulated dollar amount established for certain health care services while other services are reimbursed on a cost or fee-for-service basis.

Those hospitals that participate in the Medicare program.

A doctor or supplier who agrees to accept assignment on all Medicare claims. These doctors or suppliers may bill you only for Medicare deductible and/or coinsurance amounts. (See Assignment.)

A hospital employee whose job is to speak on a patient’s behalf and help patients get any information or services they need.

Equipment to move a patient from a bed or wheelchair using your strength or a motor.

The clinical and statistical analysis of data sets. Frequently used ESRD data sets include the PMMIS, USRDS, the core indicators, Network files, or CMS analytic files.

A financing scheme in which taxes are scheduled to produce just as much income as required to pay current benefits, with trust fund assets built up only to the extent needed to prevent exhaustion of the fund by random fluctuations.

In health care, an entity that assumes the risk of paying for medical treatments. This can be an uninsured patient, a self-insured employer, a health plan, or an HMO.