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A national coverage determination (NCD) [1] is a United States nationwide determination of whether Medicare will pay for an item or service. [2] It is a form of utilization management and forms a medical guideline on treatment.
The summary of the National Health Care Act as proposed in the 111th Congress (2009–2010) includes the following elements, among others: [10] Expands the Medicare program to provide all individuals residing in the 50 states, Washington, D.C., and territories of the United States with tax-funded health care that includes all medically necessary care.
An 834 file contains a string of data elements, with each representing a fact, such as a subscriber’s name, hire date, etc. The entire string is called a transaction set. The 834 is used to transfer enrollment information from the sponsor of the insurance coverage, benefits, or policy to a payer.
Medicare manual that provides exhaustive information about the practical use of CMNs, particularly section 5.3. This is the official source of information for contractors administering the Medicare system about the use of CMNs.
Medicare.gov logo. Medicare Advantage (Medicare Part C, MA) is a type of health plan offered by private companies which was established by the Balanced Budget Act (BBA) in 1997. This created a private insurance option that wraps around traditional Medicare. Medicare Advantage plans may fill some coverage gaps and offer alternative coverage ...
A study by the Government Accountability Office (GAO) found that the integration of Medicare and Medicaid benefits generally improves the care provided to dual-eligibles but does not lead to Medicare savings or a reduction in costly Medicare services (i.e., emergency room visits, hospital admissions, and 30-day risk-adjusted all-cause ...
SCAN Health Plan (SCAN) is a not-for-profit, Medicare Advantage based in Long Beach, California. Founded in 1977, SCAN provides healthcare coverage to Medicare beneficiaries in California, Arizona, Texas and Nevada, serving more than 285,000 members. It is one of the largest not-for-profit Medicare Advantage plans in the country. [2]
The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation.