* Unless otherwise noted all entries are from the Medicare Glossary
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A | B | C | D | E | F | G | H | I | J | K | L | M
N | O | P | Q | R | S | T | U | V | W | X | Y | Z
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ABUSE - When another person does something on purpose that causes you mental or physical harm or pain.
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ACCESS - Your ability to get needed medical care and services.
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ACCESSIBILITY OF SERVICES - Your ability to get medical care and services when you need them.
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ACCREDITED - Means having a seal of approval. Being accredited means that a facility or health care
organization has met certain quality standards. These standards are set by private, nationally recognized groups that
check on the quality of care at health care facilities and organizations. Organizations that accredit
Medicare Managed Care Plans include the
National Committee for Quality Assurance, the Joint Commission on Accreditation of
Healthcare Organizations, and the American
Accreditation HealthCare Commission/URAC.
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ACTING OUT* - A term that is generally used when the observer believes that the child's behavior is an expression of unconscious
wishes or feelings. Frequently used in describing undesirable behavior.
* Our Special Kids.Org
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ACTIVITIES OF DAILY LIVING - Activities you usually do during a normal day such as getting in and out of
bed, dressing, bathing, eating, and using the bathroom.
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ACTUAL CHARGE - The amount of money a doctor or supplier charges for a certain medical
service or supply. This amount is often more than the amount Medicare or an Insurer approves.
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ADAPTIVE BEHAVIOR* - In general, behavior that enables the individual to "fit in" with their environment and peers.
* Our Special Kids.Org
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ADDITIONAL BENEFITS - Health care services not covered by Medicare and reductions in premiums or cost sharing for
Medicare-covered services. Additional benefits are specified by the MA Organization and are
offered to Medicare beneficiaries at no additional premium. Those benefits must be at least equal in value to the adjusted excess
amount calculated in the ACR. An excess amount is created when the average payment rate exceeds the adjusted community rate (as
reduced by the actuarial value of coinsurance, copayments, and deductibles under Medicare Part A
and Medicare Part B of ). The excess amount is then adjusted for any contributions to a
stabilization fund. The remainder is the adjusted excess, which will be used to pay for services not covered by Medicare and/or
will be used to reduce charges otherwise allowed for Medicare-covered services. Additional benefits can be subject to
cost sharing by plan enrollees. Additional benefits can also be different for each MA plan offered
to Medicare beneficiaries.
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ADMITTING PHYSICIAN - The doctor responsible for admitting a patient to a hospital or other
inpatient health facility.
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AFFILIATED PROVIDER - A health care provider or facility that is paid by a health
plan to give service to plan members.
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AGE-APPROPRIATE* - At the right level for the chronological (actual) age of the child/student. The descriptor can be applied to
materials, curriculum, modifications for the child, or to the student's behavior. As an example, to say that a child is acting extremely immaturely
is to say that he is not behaving in age-appropriate ways.
* Our Special Kids.Org
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ALZHEIMER'S DISEASE* - Alzheimer's disease is a progressive condition that affects areas of the brain involved in memory,
intelligence, judgment, language, and behavior. It is the most common form of mental decline, or dementia, in older adults.
Alzheimer's disease is more severe than the mild memory loss that many people experience as they grow older. Alzheimer's disease also affects
behavior, personality, the ability to think clearly, and the ability to carry out daily activities. Close family members usually notice symptoms
first, although the person affected also may realize that something is wrong.
* WebMD Medical Library
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AMBULATORY CARE - All types of health services that do not require an overnight hospital stay.
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AMYOTROPHIC LATERAL SCLEROSIS (ALS)* - Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a progressive
wasting away of certain nerve cells of the brain and spinal column called motor neurons. The motor neurons control the voluntary muscles, which
re the muscles that allow movement.
ALS is a progressive, disabling, usually fatal disease. Walking, speaking, eating, swallowing, breathing, and other basic functions become more
difficult with time. These problems can lead to injury, illness, and other complications.
In the United States and most other parts of the world, 1 to 2 people per 100,000 develop ALS each year. Men are affected slightly more often
than women. Although ALS may occur at any age, it is most common in middle-aged and older adults.
* WebMD Medical Library
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ANCILLARY SERVICES - Professional services by a hospital or other
inpatient health program. These may include x-ray, drug, laboratory, or other services.
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APHASIA* - Aphasia is the loss of speech and language abilities caused by damage to the brain. Some individuals with this disorder
may have no speech, while others may have only mild difficulties recalling names or words. Others may have problems making a sentence. The ability
to read, write, understand directions and deal with numbers may also be impaired. In some instances of aphasia, the problem eventually resolves itself;
in other cases, the condition is irreversible.
* WebMD Medical Library
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APPROVED AMOUNT - The fee Medicare sets as reasonable for a covered medical service.
This is the amount a doctor or supplier is paid by you and Medicare for a service or supply. It may be less than the a tual amount
charged by a doctor or supplier. The approved amount is sometimes called the "Approved Charge."
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ASPERGER'S SYNDROME* - Asperger’s syndrome is a developmental disorder in which people have difficulties understanding how
to interact socially.
People with Asperger's syndrome have some traits of autism, especially weak social skills and a preference for sameness and routine. However,
unlike those with autism, children with Asperger's syndrome usually start to talk around 2 years of age (the age at which speech normally
develops). They have normal to above-normal intelligence.
Both conditions belong to the group of disorders called pervasive developmental disorders. A recent study of a U.S. community of 76,000 found
as many as 3 out of every 1,000 children were affected by Asperger's syndrome.
* WebMD Medical Library
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ASSESSMENT - The gathering of information to rate or evaluate your health and needs, such as in a
nursing home.
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ASSISTED LIVING - A type of living arrangement in which personal care services
such as meals, housekeeping, transportation, and assistance with activities of daily living are available as needed to people who
still live on their own in a residential facility. In most cases, the "assisted living" residents pay a regular monthly rent. Then,
they typically pay additional fees for the services they get.
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AUDITORY INTEGRATION TRAINING* - An experimental procedure for reducing painful hypersensitivity to sound. It has proved beneficial for
some people with autism and other neuropsychiatric disorders.
* Our Special Kids.Org
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AUTISM* - Autism is a disorder of brain function that appears early in life, generally before the age of three. Children with
autism have problems with social interaction, communication, imagination and behavior. Autistic traits persist into adulthood, but vary in severity.
Some adults with autism function well, earning college degrees and living independently. Others never develop the skills of daily living, and may be
incorrectly diagnosed with a variety of psychiatric illnesses. The cause is unknown.
* WebMD Medical Library
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