Glossary

The X12 Application Control Totals transaction.

The withholding of payment by an FI or carrier from a provider or supplier of an approved Medicare payment amount before a determination of the amount of the overpayment exists.

The way that payments to health plans are changed to take into account a person's health status.

The way that Medicare pays for most outpatient services at hospitals or community mental health centers under Medicare Part B.

The way that Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you go to a hospital or skilled nursing facility. The benefit period ends when you haven’t received any hospital care (or skilled care in a SNF) for 60 days in a row. If you go into the hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins if you are in the Original Medicare Plan. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have.

The way in which an individual, group, or organization carries out or accomplishes its important functions or processes.

The updated estimate of the most recent historical year.

The uniform professional claim form.

The uniform institutional claim form.

The type of care or service furnished to an ESRD patient. Such types of care are transplantation; dialysis; outpatient dialysis; staff assisted dialysis; home dialysis; and self-dialysis and home dialysis training.