Glossary

Information, hard copy or electronic, related to a particular claim. Attachments may be structured (such as Certificates of Medical Necessity) or non-structured (such as an Operative Report). Though attachments may be submitted separately, it is common to say the attachment was "submitted with the claim."

Values relating to future trends in certain key factors that affect the balance in the trust funds. Demographic assumptions include fertility, mortality, net immigration, marriage, divorce, retirement patterns, disability incidence and termination rates, and changes in the labor force. Economic assumptions include unemployment, average earnings, inflation, interest rates, and productivity. Three sets of economic assumptions are presented in the Trustees Report:

1. The low cost alternative, with relatively rapid economic growth, low inflation, and favorable (from the standpoint of program financing) demographic conditions;
2. The intermediate assumptions, which represent the Trustees' best estimates of likely future economic and demographic conditions; and
3. The high cost alternative, with slow economic growth, more rapid inflation and financially disadvantageous demographic conditions.

See also Hospital assumptions.

An organization that promotes the use of EDI in the health care industry.

A type of living arrangement in which personal care services such as meals, housekeeping, transportation, and assistance with activities of daily living are available as needed to people who still live on their own in a residential facility. In most cases, the "assisted living" residents pay a regular monthly rent. Then, they typically pay additional fees for the services they get.

In the Original Medicare Plan, this means a doctor agrees to accept the Medicare-approved amount as full payment. If you are in the Original Medicare Plan, it can save you money if your doctor accepts assignment. You still pay your share of the cost of the doctor's visit.

A claim submitted for a service or supply by a provider who accepts Medicare assignment.

Treasury notes and bonds guaranteed by the federal government, and cash held by the trust funds for investment purposes.

The gathering of information to rate or evaluate your health and needs, such as in a nursing home.

Educational publications/documents that provide coding and coverage guidance on a subject that also may have an associated LCD. Articles may be categorized as:

• Key articles: Articles designated by the contractor as being associated/pertinent to a specific LCD(s)
• FAQ: Article developed due to providers frequent inquiries that provide specific information on a particular topic
• SAD Exclusion (Self-Administered Drug Exclusion List Article): Articles that list the CPT/HCPCS codes that are excluded from coverage under this category - Self Administered Drug Exclusion Article.

State and local programs that help older people plan and care for their life-long needs. These needs include adult day care, skilled nursing care/therapy, transportation, personal care, respite care, and meals.