Glossary

The surgical procedure of excising a kidney from a living donor and implanting it into a suitable recipient.

The surgical procedure of excising a kidney from a deceased individual and implanting it into a suitable recipient.

The standard Medicare Part B premium will go up ten percent for each full 12-month period (beginning with the first month after the end of your Initial Enrollment Period) that you could have had Medicare Part B but didn’t take it. The additional premium amount is called a “premium surcharge.” There will be a surcharge for Part D also.

The Social Security programs that pay for (1) monthly cash benefits to retired-worker (old-age) beneficiaries, their spouses and children, and survivors of deceased insured workers (OASI); and (2) monthly cash benefits to disabled-worker beneficiaries and their spouses and children, and for providing rehabilitation services to the disabled (DI).

The service:

• does not meet the requirements of a Medicare benefit category,
• Is statutorily excluded from coverage on ground other than 1862(a)(1), or
• is not reasonable and necessary under 1862 (a)(1).

The SEER Program of the National Cancer Institute is the most authoritative source of information on cancer incidence and survival in the United States. For further information go to: http://seer.cancer.gov.

The Secretary of Health and Human Services.

The SDP is a drug-pricing file containing the allowable price for each drug covered incident to a physician’s service, drugs furnished by independent dialysis facilities that are separately billable from the composite rate, and clotting factors to inpatients. The SDP is, in effect, a fee schedule, similar to other CMS fee schedules.

The scope, terms and/or condition(s) of coverage including any limitation(s) associated with the plan provision of the service.

The rules and conventions that one needs to know or follow in order to validly record information, or interpret previously recorded information, for a specific purpose. Thus, a syntax is a grammar. Such rules and conventions may be either explicit or implicit. In X12 transactions, the data-element separators, the sub-element separators, the segment terminators, the segment identifiers, the loops, the loop identifiers (when present), the repetition factors, etc., are all aspects of the X12 syntax. When explicit, such syntactical elements tend to be the structural, or format-related, data elements that are not required when a direct data entry architecture is used. Ultimately, though, there is not a perfectly clear division between the syntactical elements and the business data content.