Medicare Advantage Organization definition

Medicare Advantage Organization means a public or private organization licensed by the State as a risk-bearing entity that is under contract with CMS to provide the Medicare Advantage Benefit Package as defined in this Agreement.
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Medicare Advantage Organization means a public or private entity organized and licensed by a State as a risk-bearing entity (with the exception of provider-sponsored organizations receiving waivers) that is certified by CMS as meeting the Medicare Advantage contract requirements.
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Medicare Advantage Organization means a private company that has a contract with Medicare to provide Medicare Advantage plans and benefits to individuals.
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Examples of Medicare Advantage Organization in a sentence

  • To promote alignment between Medicaid and Medicare, each beneficiary who is enrolled with a Medicare Advantage Organization, must first be assigned to any MMA plan in the beneficiary’s region that is operated by the same parent organization as the beneficiary’s Medicare Advantage Organization.

  • Services or supplies that are not within the categories of Benefits selected by your Medicare Advantage Organization and that are not covered under the terms of this Certificate.

  • Final Contract Period: the final term of the contract between CMS and the Medicare Advantage Organization.

  • Member or Enrollee: a Medicare Advantage eligible individual who has enrolled in or elected coverage through a Medicare Advantage Organization.

  • Completion of Audit: completion of audit by the Department of Health and Human Services, the Government Accountability Office, or their designees of a Medicare Advantage Organization, Medicare Advantage Organization contractor or related entity.

  • Under the CMS risk adjustment model, the Medicare Advantage Organization is permitted to submit diagnosis data from inpatient hospital, outpatient hospital and physician encounters only.

  • Risk adjustment is the process used by CMS to adjust the payment made to the Medicare Advantage Organization based on the health status of the Medicare Advantage Organization’s Medicare Advantage members.

  • This ensures the integrity and accuracy of risk adjusted payments to the Medicare Advantage Organization (MAO).

  • Medical Record Documentation Requirements (Risk Adjustment)Medical records significantly impact risk adjustment because:• They are a valuable source of diagnosis data;• They dictate what ICD-10 Code is assigned;• They are used to validate diagnosis data that was previously provided to CMS by the Medicare Advantage Organization.

  • If the Medicare Advantage Organization is selected by CMS to participate in a RADV audit, the Medicare Advantage Organization and the providers that treated the MA members included in the audit will be required to submit medical records to validate the diagnosis data previously submitted.


More Definitions of Medicare Advantage Organization

Medicare Advantage Organization. (“MA Organization”): A public or private entity organized and licensed by a state as a risk-bearing entity (with the exception of provider-sponsored organizations receiving waivers) that is certified by CMS as meeting the MA contract requirements.
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Medicare Advantage Organization means a private company that has a contract with Medicare to provide Medicare Advantage plans and benefits to individuals.37.36(2) Guaranteed issue.
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Medicare Advantage Organization means a public or private entity organized and licensed by a state Governmental Authority as a risk-bearing entity
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Medicare Advantage Organization. (“MAO”) means a Health Plan that has entered into an agreement with the CMS to provide services to Medicare beneficiaries under the Medicare Advantage Program.
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Medicare Advantage Organization means an organization holding a contract with CMS to offer a Medicare Advantage Plan to eligible beneficiaries of Medicare.
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Related to Medicare Advantage Organization

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Health care organization ’ means any person or en-

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Provider Organization means a group practice, facility, or organization that is:

  • Religious organization means a church, ecclesiastical corporation, or group, not organized for pecuniary profit, that gathers for mutual support and edification in piety or worship of a supreme deity.

  • Foreign terrorist organization means an organization designated as a foreign terrorist organization by the United States secretary of state as authorized by 8 U.S.C. Section 1189.

  • Nonprofit organization means a university or other institution of higher education or an organization of the type described in section 501(c)(3) of the Internal Revenue Code of 1954 (26 U.S.C. 501(c) and exempt from taxation under section 501(a) of the Internal Revenue Code (25 U.S.C. 501(a)) or any nonprofit scientific or educational organization qualified under a state nonprofit organization statute.

  • Review organization means a disability insurer regulated

  • Student organization means a group, club or organization having students as its primary members or participants. It includes grade levels, classes, teams, activities or particular school events. A student organization does not have to be an official school organization to come within the terms of this definition.

  • Labor organization means any organization of any kind, or any agency or employee representation committee or plan, in which employees participate and that exists for the purpose, in whole or in part, of dealing with employers concerning grievances, labor disputes, wages, rates of pay, hours of employment, or conditions of work.

  • Member organization means any individual, corporation, limited liability company, partnership, or association that belongs to an association.

  • Employee organization means any organization, union, or

  • Professional employer organization means an employee leasing

  • Health care facility or "facility" means hospices licensed

  • Business organization means an individual, partnership, association, joint stock company, trust, corporation or other legal business entity or successor thereof.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.