Title XVIII Medicare Sample Clauses

Title XVIII Medicare. Revenue as a result of an arrangement between a provider and the Centers for Medicare and Medicaid Services for services to a Medicare beneficiary.

Title XVIII Medicare. A federally-financed health insurance program administered by the Centers for Medicare and Medicaid Services (CMS) pursuant to 42 U.S.C. 1395 et seq., covering almost all Americans sixty-five (65) years of age and older and certain individuals under sixty-five (65) who are disabled or have chronic kidney disease.‌ Transitional Care Home — A tertiary care center which provides medical and personal care services to children upon discharge from the hospital that require intensive medical care for an extended period of time. This transition allows for the caregiver to be trained in the care of the child, so that the child can eventually be placed in the caregiver's home.‌ Urgent Medical Condition — Any illness, injury or severe condition which under reasonable standards of medical practice would be diagnosed and treated within a twenty-four (24) hour period and if left untreated, could rapidly become a crisis or Emergency Medical Condition. The term also includes situations where a person's discharge from a hospital will be delayed until services are approved or a person's ability to avoid hospitalization depends upon prompt approval of services.‌ Utilization Management (UM) — An objective and systematic process for planning, organizing, directing and coordinating healthcare resources to provide Medically Necessary, timely and quality healthcare services in the most cost- effective manner.‌ Utilization Review Criteria — Detailed standards, guidelines, decision algorithms, models, or informational tools that describe the factors to be considered relevant to making determinations of need for services including, but not limited to, level of care, place of service, scope of service, and duration of service.‌