P.Q.R.S (Physician Quality Reporting System) a voluntary - ANSWER incentive-based quality
reporting system for eligible professionals who report data on quality measures for covered
professional services provided to Medicare beneficiaries; established as a requirement by the
2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) and implemented yearly by CMS
through an annual rule-making process; therefore, program requirements and measures may
vary from year to year.
Surgeon - ANSWER
Black appt. System - ANSWER
Local Coverage Determination (LCD) - ANSWER a decision made by a Medicare Administrative
Contractor (MAC) on whether a particular service or item is reasonable and necessary, and
therefore covered by Medicare within the specific region that the MAC oversees.
Community Health Centers - ANSWER are non-profit organizations that provide primary health
care for individuals, families and communities.
Medicare Physician Fee Schedule - ANSWER
R.R.T (Registered Respiratory Therapist) - ANSWER
, 3 items of dialysis - ANSWER
Validation survey - ANSWER a survey conducted by a regional office of the CMS to determine
whether the surveys being conducted by state agencies (or other groups)are assessing the
facility's operations appropriately.
ESRD network - ANSWER established by federal law to monitor quality and appropriateness of
care provided to ESRD patients. These ESRD networks perform their work under contract with
the Centers for Medicare & Medicaid Services (CMS).
Dialysis facility - ANSWER "an entity that provides (1) outpatient maintenance dialysis services;
or (2) home dialysis training and support services; or (3) both. A dialysis facility may be an
independent or hospital based unit...or a self-care dialysis unit that furnishes only self-dialysis
services"
H.I.T (Health Information Technology) - ANSWER electronic health records and related
information systems to manage health care processes; the major focus of the HITECH Act of
2009 is to promote adoption of HIT in an effort to improve the quality, efficiency, and safety of
health care delivery while reducing costs and minimizing medical errors.
Medicaid - ANSWER Title XIX of the 1965 Amendments to the Social Security Act. Medicaid is
jointly funded by federal and state governments and provides medical assistance to lower-
income individuals and families. Each state establishes and administers its own program, so
requirements differ from state to state
RAC (Recovery Audit Contractor) - ANSWER a third-party entity working under the direction of
CMS to detect improper Medicare payments by reviewing providers' medical records and
Medicare claims data.
HIPAA (Health Insurance Portability and Accountability Act of 1996) - ANSWER also known as
the Kassebaum-Kennedy Act. Provisions include the portability of health care benefits (for
reporting system for eligible professionals who report data on quality measures for covered
professional services provided to Medicare beneficiaries; established as a requirement by the
2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) and implemented yearly by CMS
through an annual rule-making process; therefore, program requirements and measures may
vary from year to year.
Surgeon - ANSWER
Black appt. System - ANSWER
Local Coverage Determination (LCD) - ANSWER a decision made by a Medicare Administrative
Contractor (MAC) on whether a particular service or item is reasonable and necessary, and
therefore covered by Medicare within the specific region that the MAC oversees.
Community Health Centers - ANSWER are non-profit organizations that provide primary health
care for individuals, families and communities.
Medicare Physician Fee Schedule - ANSWER
R.R.T (Registered Respiratory Therapist) - ANSWER
, 3 items of dialysis - ANSWER
Validation survey - ANSWER a survey conducted by a regional office of the CMS to determine
whether the surveys being conducted by state agencies (or other groups)are assessing the
facility's operations appropriately.
ESRD network - ANSWER established by federal law to monitor quality and appropriateness of
care provided to ESRD patients. These ESRD networks perform their work under contract with
the Centers for Medicare & Medicaid Services (CMS).
Dialysis facility - ANSWER "an entity that provides (1) outpatient maintenance dialysis services;
or (2) home dialysis training and support services; or (3) both. A dialysis facility may be an
independent or hospital based unit...or a self-care dialysis unit that furnishes only self-dialysis
services"
H.I.T (Health Information Technology) - ANSWER electronic health records and related
information systems to manage health care processes; the major focus of the HITECH Act of
2009 is to promote adoption of HIT in an effort to improve the quality, efficiency, and safety of
health care delivery while reducing costs and minimizing medical errors.
Medicaid - ANSWER Title XIX of the 1965 Amendments to the Social Security Act. Medicaid is
jointly funded by federal and state governments and provides medical assistance to lower-
income individuals and families. Each state establishes and administers its own program, so
requirements differ from state to state
RAC (Recovery Audit Contractor) - ANSWER a third-party entity working under the direction of
CMS to detect improper Medicare payments by reviewing providers' medical records and
Medicare claims data.
HIPAA (Health Insurance Portability and Accountability Act of 1996) - ANSWER also known as
the Kassebaum-Kennedy Act. Provisions include the portability of health care benefits (for
