Medicare

Accreditation
A process where external organizations (or "accrediting bodies") evaluate health care facilities' policies, procedures, and performance to make sure they are meeting predetermined criteria.
Advance Beneficiary Notice (ABN)
In Original Medicare, a notice that a doctor, supplier, or provider gives a Medicare beneficiary before furnishing an item or service if the doctor, supplier,or provider believes that Medicare may deny payment. In this situation, if you aren't given an ABN before you get the item or service, and Medicare denies payment, then you may not have to pay for it. If you are given an ABN, and you sign it, you will probably have to pay for the item or service if Medicare denies payment.
Advance Coverage Decision
A notice you get from a Medicare Advantage Planletting you know in advance whether it will cover a particular service.
Advance Directive
A written document stating how you want medical decisions to be made if you lose the ability to make them for yourself. It may include a Living Will and a Durable Power of Attorney for health care.
ALS
Amyotrophic lateral sclerosis, also known as Lou Gehrig's disease.
Ambulatory Surgical Center
Afacility where simpler surgeries are performed for patients who aren't expected to need more than 24 hours of care.
Angina Pectoris
Chest pain.
Angioplasty
A medical procedure used to open a blocked artery.
Appeal
An appeal is the action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan. Youcan appeal if Medicare or your plan denies one of the following:
* Your request for a health care service, supply, or prescription that you think you should be able to get
* Your request for payment for health care or a prescription drug you already got
* Your request to change the amount you must pay for a prescription drug
You can also appeal if you're already getting coverage andMedicare or your plan stops paying.
Assignment
An agreement by your doctor or other supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
Beneficiary
A person who has health care insurance through the Medicare or Medicaid programs.
Benefit Period
The way thatOriginal Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you're admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven't received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefitperiod has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods.

Centers for Medicare & Medicaid Services (CMS)
The Federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Programs.
Certified (Certification)
See "Medicare-certified provider"
Children's HealthInsurance Program (CHIP)
A joint Federal and state program that provides free or low-cost health coverage for children up to age 19.
Claim
A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered.
Clinical Breast Exam
An exam by your doctor or other health care provider to check for breast cancer by feeling andlooking at your breasts. This exam isn't the same as a mammogram and is usually done in the doctor's office during your Pap test and pelvic exam.
Coinsurance
An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Comprehensive Outpatient Rehabilitation Facility
A facility that provides a...