Glossary
Tags
- ACA
- ACA Marketplace
- ACA subsidies
- CHIP
- CMS
- ESRD
- Extra Help
- FMAP
- FPL
- FQHC
- FSA
- HCBS
- HMO
- HRA
- HSA
- IEP
- IRMAA
- Joint Commision
- KFF
- LCD
- LIS
- Marketplace
- Medicaid
- Medicaid (rare)
- Medicaid expansion
- Medicare
- Medicare Advantage
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare coordination
- Medigap
- NCD
- NEMT
- NOMNC
- Original Medicare
- PCP
- Part A
- Part B
- Part C
- Part D
- QLE
- QMB
- SEP
- SNF
- SNP
- SSI
- Section 1115
- Silver Plan
- Silver plan
Fee-for-Service (FFS)
A traditional healthcare payment model in which healthcare providers are paid separately for each service provided to a patient, such as doctor visits, tests, or procedures. Medicare and Medicaid offer FFS options, although many states are moving towards managed care models.
A traditional healthcare payment model in which healthcare providers are paid separately for each service provided to a patient, such as doctor visits, tests, or procedures. Medicare and Medicaid offer FFS options, although many states are moving towards managed care models.
Global Payment
A type of payment arrangement in which a provider is paid a fixed amount for all care provided to a patient over a specified period, regardless of the actual number of services rendered. Global payment models are sometimes used in Medicare and Medicaid to improve cost control.
A type of payment arrangement in which a provider is paid a fixed amount for all care provided to a patient over a specified period, regardless of the actual number of services rendered. Global payment models are sometimes used in Medicare and Medicaid to improve cost control.
Risk Adjustment
A process used by health insurance companies to adjust payments based on the health status of their enrollees. It ensures that plans enrolling higher-risk individuals (such as those with chronic conditions) are compensated to maintain financial stability. Medicare Advantage and ACA Marketplace plans use risk adjustment.
A process used by health insurance companies to adjust payments based on the health status of their enrollees. It ensures that plans enrolling higher-risk individuals (such as those with chronic conditions) are compensated to maintain financial stability. Medicare Advantage and ACA Marketplace plans use risk adjustment.
Value-Based Care
A healthcare delivery model in which providers are reimbursed based on patient health outcomes rather than the number of services delivered. Medicare, Medicaid, and some ACA programs have adopted value-based care models to improve quality and reduce costs.
A healthcare delivery model in which providers are reimbursed based on patient health outcomes rather than the number of services delivered. Medicare, Medicaid, and some ACA programs have adopted value-based care models to improve quality and reduce costs.