Glossary of Terms
BI: Benefit Integrity
General name for activities aimed at reducing fraud and abuse in the Medicare program, performed under the PSC contract. As Integriguard performs this function in the Midwest states of Nebraska, Kansas, and Missouri, we lump these activities under the name of "Midwest Integrity Center."
CMS: Centers for Medicare & Medicaid Services
Federal government agency that stewards state and federal programs of the same name. [NOTE: The single 'M' is representative of both Medicare/Medicaid.]
HIPAA: Health Information Portability & Accountability Act
Legislation passed in 1996 having far-reaching effects on extending efficiency, privacy, and security in the healthcare industry. HIPAA allows one to buy and continue health insurance coverage, regardless of employment or the state of personal health. HIPAA created a program called the (Medicare Integrity Program (MIP), which is the payment safeguard work IntegriGuard performs as a PSC contractor.
Home Health Agency
A carrier that cares for patients confined at home due to a sickness or injury requiring skilled healthcare services on an intermittent, part-time basis.
IDIQ: Indefinite Delivery Indefinite Quantity
a.k.a. 'umbrella contract' or 'IDIQ vehicle.' Refers to federal government agency contract programs for which businesses first apply for eligibility. This means that at the time the contract is awarded, the government does not yet know how many services or products it wanted or when it wanted them. A contract can be either indefinite-delivery or indefinite-quantity, or both. After passing the screening and application process, businesses then have the choice to competitively bid against other eligible contractors for mini-contracts, called 'task orders' within that IDIQ.
Medicaid
Jointly funded federal and state program that provides hospital expense and medical expense coverage to the low-income population and certain aged and disabled individuals.
Medicare
Federal government hospital expense and medical expense insurance plan primarily for elderly and disabled persons.
Medicare Advantage
a.k.a. 'Medicare Plus Choice' or 'M+CQRO.'
Medicare Part A
a.k.a. 'hospital insurance.' Refers to the part of Medicare that provides basic hospital insurance, as well as skilled nursing facility, home healthcare, and hospice care if following a covered hospital stay. Most people do not have to pay for Medicare Part A since they or their spouse paid Medicare taxes while they were working.
Medicare Part B
a.k.a. 'medical insurance.' Refers to a voluntary program that is part of Medicare and provides benefits to cover the costs of physicians' services, outpatient hospital care, and other medical services (such as diagnostic tests and ambulance services) that are not covered by Part A. After age 65, individuals who choose to enroll in the program pay monthly premiums and an annual deductible for services covered by the program.
Medicare Part C
a.k.a. 'Medicare Advantage' or formerly, 'Medicare + Choice.' Portion of Medicare that expands the list of different types of entities allowed to offer health plans to Medicare beneficiaries.
Medicare Part D
a.k.a. 'Medicare Prescription Drug Plan.' Voluntary program in which Medicare members may enroll. Members choose between at least two private plans, Medicare approved managed care, or HMO plans that offer drug coverage. Beneficiaries are charged an extra premium each month to join one of these plans and receive the Medicare Part D drug benefit.
Medicare Supplement
A private medical expense insurance plan that supplements Medicare coverage. Also known as a Medigap policy.
Medigap
See 'Medicare supplement.'
MIP: Medicare Integrity Program
Program set forth in the 1996 HIPAA legislation calling for PSC contractors to perform Medicare payment safeguard work, among other duties.
MMA: Medicare Prescription Drug, Improvement and Modernization Act of 2003
Provides seniors and people living with disabilities with a prescription drug benefit, more choices and better benefits under Medicare. Part of the MMA formed the PDDC-TAP program for which IntegriGuard is responsible.
MMC-PIC: Medicare Managed Care - Program Integrity Contractor
Refers both to an IDIQ umbrella contract and a type of business or 'contractor' that has earned the right to bid on that umbrella contract work.
MMCPV: Medicare Managed Care Payment Validation
A 'task order,' or work under the MMC-PIC umbrella contract that involves processing retroactive enrollment and payment adjustments.
PDDC-TAP: Prescription Drug Discount Card and Transitional Assistance Program
Refers to a voluntary program enacted into law as part of the Medicare Modernization Act of 2003. Medicare beneficiaries, with the exception of those with Medicaid drug coverage, can enroll in this program and receive a discount card to help lower their drug costs off the regular cash price of prescriptions. These cards primarily benefit individuals with no outpatient prescription drug insurance. PDDC-TAP gives immediate relief to Medicare beneficiaries until the new drug benefit is implemented on January 1, 2006.
PSC: Program Safeguard Contractor
Refers both to an IDIQ umbrella contract and a type of business or 'contractor' that has earned the right to bid on PSC umbrella contract work.
QIC: Qualified Independent Contractor
Refers both to an IDIQ umbrella contract and a type of business or 'contractor' that has earned the right to bid on QIC umbrella contract work.
RFP: Request For Proposal
A document outlining a government agency's requirements for proposed contractual work, and the criteria for the evaluation of bids / offers.
SNF: Skilled Nursing Facility
A facility, licensed in accordance with state law, which is Medicare eligible as a supplier of skilled inpatient nursing care. Primarily engaged in providing skilled nursing and other therapeutic services.
SSA: Social Security Act
The law that created Medicare, Medicaid, and other Federal programs {Old Age, Survivors and Disability Insurance Benefits (Social Security or OASDI), Aid to Families with Dependent Children (AFDC), Child Welfare, Child Support, Foster Care, Job Opportunities and Basic Skills Training, Maternal and Child Health Services, Supplemental Security Income (SSI), Social Services Block Grant (SSBG), Child Health Insurance Program (CHIP)}.
Task Order
A mini-contract which lays out specific work requirements under a larger 'umbrella contract.' MMCPV, PDDC-TAP, et al. are examples of task orders.