Glossary

Review, pre- or postpayment, that requires the intervention of PSC personnel.

Manual transmittals announce policy revisions. National coverage determinations are announced in transmittals for the Medicare National Coverage Determinations Manual. Changes to Local Medical Review Policy are announced in transmittals for the Medicare Program Integrity Manual.

See "Hospital market basket."

A location where providers administer pneumococcal pneumonia and influenza virus vaccination and submit these services as electronic media claims, paper claims, or using the roster billing method. This generally takes place in a mass immunization setting, such as a public health center, pharmacy, or mall but may include a physician's office setting (4408.8, Part 3 of MCM).

A serious flaw in management controls requiring high-priority corrective action.

Under HIPAA, this is all of the required data elements for a particular standard based on a specific implementation specification. An entity creating a transaction is free to include whatever data any receiver might want or need. The recipient is free to ignore any portion of the data that is not needed to conduct their part of the associated business transaction, unless the inessential data is needed for coordination of benefits.

The beneficiary's maximum dollar liability amount for a specified period.

The maximum dollar amount per period that a plan will insure. This is only applicable forservice categories where there are enhanced benefits being offered by the plan, becauseMedicare coverage does not allow a Maximum Plan Benefit Coverage expenditure limit.

Annual dollar amount above which earnings in employment covered under the HI program are not taxable. Beginning in 1994, the maximum tax base is eliminated under HI.

See "Maximum tax base."