Continuing Medical Education (CME)
Required classes for physicians and others in the medical field for professional development and to learn the latest research.
Coordinating Care for Dual Eligibles
Process designed to streamline care for people who are eligible for both Medicare and Medicaid- overseen by the Federal Coordinated Health Care Office.
Coordination of Benefits
An administrative process through which insurance providers sort out how to cover treatments covered by multiple plans. The most common example of this type of over-coverage is children who are covered by both of their parents' insurance plans.
A required cost paid by the insured person each time a medical service is used.
Strategies focused on limiting the growth of health care costs. Includes attempts to reduce overutilization of health services, address provider reimbursement issues, eliminate waste, and increase efficiency in the health care system.
A percentage of health care that is not covered by health insurance and is paid by the patient.
Cost-Sharing Reduction (CSR)
A provision in the Affordable Care Act that lowers the amount an individual pays out-of-pocket for deductibles, coinsurance, and copayments. Individuals can qualify if they are enrolled in a Silver plan through the exchange and have income that is below 250 percent of the Federal Poverty Level.
Balancing revenues by increasing costs on some payers to offset the lower reimbursement of other payers.
When a program expands to meet the needs of patients when the economy is in decline. As the program grows the costs also rise.
Coverage of Preventive Benefits
Provision in the ACA requiring full coverage of preventative services with no cost-sharing, including children’s’ immunizations and women’s screenings and care.