Glossary

Glossary and Acronyms
Term	Definition Sort descending
COMMERCIAL MCO	A Commercial MCO is a health maintenance organization, an eligible organization with a contract under §1876 or a Medicare-Choice organization; a provider sponsored organization, or any other private or public organization, which meets the requirements of §1902(w). These MCOs provide comprehensive services to commercial and/or Medicare enrollees, as well as Medicaid enrollees.
MEDICARE PAYMENT ADVISORY COMMISSION	A commission established by Congress in the Balanced Budget Act of 1997 to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission. MedPAC is directed to provide the Congress with advice and recommendations on policies affecting the Medicare program.
GRIEVANCE	A complaint about the way your Medicare health plan is giving care. For example, you may file a grievance if you have a problem calling the plan or if you are unhappy with the way a staff person at the plan has behaved toward you. A grievance is not the way to deal with a complaint about a treatment decision or a service that is not covered (see Appeal).
FEE SCHEDULE	A complete listing of fees used by health plans to pay doctors or other providers.
AVERAGE MARKET YIELD	A computation that is made on all marketable interest-bearing obligations of the United States. It is computed on the basis of market quotations as of the end of the calendar month immediately preceding the date of such issue.
DATA MODEL	A conceptual model of the information needed to support a business function or process.
INFORMATION MODEL	A conceptual model of the information needed to support a business function or process.
ANEMIA	A condition occurring when the blood is deficient in red blood cells and / or hemoglobin which decrease the oxygen carrying capacity of the blood.
STATE LAW	A constitution, statue, regulation, rule, common law, or any other State action having the force and effect of law.
PRIVATE CONTRACT	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.