Medicare Laboratory Payment Policy Now and in the Future (2000) / Chapter Skim
Currently Skimming:
Acronyms and Glossary
Acronyms and Glossary
Pages 163-172
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From page 163... ...
Acronyms and Glossary ACRONYMS ABN ACLA AHRQ AMA AST BBA BBRA CAC CAGR CBO CDC CHPS CK CLIA CLMA COBRA CPEP CPI CPK CPT CSC CY Advanced Beneficiary Notice American Clinical Laboratory Association Agency for Healthcare Research and Quality American Medical Association aspartate transominase Balanced Budget Act, 1997 Balanced Budget Refinement Act, 1999 Carrier Advisory Committee compound annual growth rate Congressional Budget Office Centers for Disease Control and Prevention Center for Health Policy Studies, Columbia, Maryland creatine kinase Clinical Laboratory Improvement Act, 1967; Clinical Laboratory Improvement Amendments, 1988 Clinical Laboratory Management Association Consolidated Omnibus Budget Reconciliation Act, 1985 Clinical Practice Expense Panel Consumer Price Index creatine phosphokinase Current Procedural Telminology Central Statistical Carrier calendar year 163
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From page 164... ...
POCT point-of-care testing POL physician office laboratory POS point of service PMPM per member per month PPE personal protective equipment
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From page 165... ...
. , peer review organization prostate-specific antigen proficiency testing quality assurance/quality control red blood cell Resource-based relative value scale regional laboratory carrier RVS Update Committee relative value scale serum glutamic-oxalvacetic transaminase serum glutamic-pyruvic transaminase sustainable growth rate Standard Industrial Classification skilled nursing facility Social Security Act, Social Security Administration turnaround time thyroid-stimulating hormone usual, customary, and reasonable Department of Veterans Affairs white blood cell GLOSSARY Accession: The process of identifying a specimen and entering a unique specimen identifier into laboratory records.
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From page 166... ...
Balance billing: A type of cost sharing under Medicare whereby a beneficiary is responsible for the difference between the physician's submitted charge and the Medicare-allowed charge on unassigned claims, up to a maximum permitted by Medicare. Beneficiary: An individual entitled to receive Medicare services.
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From page 167... ...
All suppliers and providers that perform laboratory testing, even if no laboratory per se is part of the facility, must also hold the appropriate valid CLIA certificate and meet applicable CLIA requirements for the testing offered. CLIA-exempt laboratory: A laboratory that has been licensed or approved by a state where HCFA has determined that the state has enacted laws relating to laboratory requirements that are equal to or more stringent than CLIA requirements and where the state licensure program has been approved by HCFA in accordance with subpart E of 42 CFR Part 493.
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From page 168... ...
Episode of care: This term is most often used in reference to the monetary costs of an individual's sickness. It includes length of care in special care unit or hospital, nursing care costs in the hospital, professional and technical services, physician services, respiratory services, respiratory therapy, pharmaceuticals, intravenous therapy, collateral diseases, and complications.
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From page 169... ...
The HMO usually receives a monthly premium or capitation payment for each enrollee that is based on a projection of what the typical patient will cost. Health professional shortage area: An urban or rural geographic area, population group, or public or nonprofit private medical facility that the Secretary of Health and Human Services determines is being served by too few health professionals.
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From page 170... ...
Medicare contractor: A commercial insurance company or a Blue Cross/Blue Shield plan that contracts with HCFA to process claims. For Part A providers, contractors are called "fiscal intermediaries;" for Part B providers they are called "carriers." Medicare Part A: The portion of Medicare that covers services provided by hospitals, skilled nursing facilities, hospices, and some home health services.
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From page 171... ...
Research test: A test in which specimens are examined for the purpose of understanding a condition better or developing a clinical test. Resource based relative value scale: A system that bases payment on the relative amount of resources required to provide a service a common payment method for physicians' services.
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From page 172... ...
Sustainable growth rate system: A revision to the volume performance standard system, enacted as part of the BBA of 1997, that serves as the mechanism for setting fee updates for the Medicare fee schedule. It uses a single conversion factor and bases target rates of growth on growth of gross domestic product and other factors.
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