Glossary

A contract between you and a doctor, podiatrist, dentist, or optometrist who has decided not to offer services through the Medicare program. This doctor can’t bill Medicare for any service or supplies given to you and all his/her other Medicare patients for at least 2 years. There are no limits on what you can be charged for services under a private contract. You must pay the full amount of the bill.

A type of Medicare Advantage Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan doesn’t cover.

Something done to fix a health problem or to learn more about it. For example, surgery, tests, and putting in an IV (intravenous line) are procedures.

The goal-directed, interrelated series of actions, events, mechanisms, or steps.

A methodology utilized to make improvements to a process through the use of continuous quality improvement methods.

A gauge that measures a goal-directed interrelated series of actions, events, mechanisms, or steps.

Spending aimed at increasing contractor operational efficiency and productivity through improved work methods, application of technology, etc.

Data segregated by specific time period (e.g. quarterly, annually) and target area (e.g. facility, State) for the purpose of identifying patterns.

CMS operational account. Program Management supplies the agency with the resources to administer Medicare, the Federal portion of Medicaid, and other Agency responsibilities. The components of Program Management are Medicare contractors, survey and certification, research, and administrative costs.

An automated system of records that contains records primarily of current Medicare-eligible ESRD patients, but also maintains historical information on people no longer classified as ESRD patients because of death or successful transplantation or recovery of renal function. The PMMIS contains medical information on patients and the services that they received during the course of their therapy. In addition, it contains information on ESRD facilities and facility payment. Beginning January 1, 1995, the PMMIS collects information on all dialysis and kidney transplant patients.