Glossary

A restorative process through which an individual with ESRD develops and maintains self-sufficient functioning consistent with his/her capability.

The encounter data did not pass the "front-end" edit process. M+CO needs to correct the data and resubmit.

A hospital unit that is approved to furnish transplantation and other medical and surgical specialty services directly for the care of ESRD transplant patients, including inpatient dialysis furnished directly or under arrangement.

An action taken, after all appeal rights are exhausted, to re-examine or question the correctness of a determination, a decision, or cost report otherwise final.

Is a way to check up on the quality of care delivered by health plans. Report cards provide information on how well a health plan treats its members, keeps them healthy, and gives access to needed care. Report cards can be published by States, private health organizations, consumer groups, or health plans.

An entity who formally requests access to CMS data.

When a requestor formally requests permission to rerelease CMS data that has been formatted into statistical or aggregated information by the recipient. CMS is responsible for reviewing the files/reports to ensure that they contain no data elements or combination of data elements that could allow for the deduction of the identity of the Medicare beneficiary or a physician and that the level of cell size aggregation meets the stated requirement.

A CMS contractor that provides free assistance to academic and non-profit
research interested in using Medicare and Medicaid data for research.

A document that outlines a strong research design, which clearly states the
objectives, background, methods and the significance of the study being
proposed.

(See Lifetime Reserve Days.)