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Glossary

This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations, and rulings.

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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


Term Definition
DATA ENTRY USER

A Data Entry User is any user that the Super User designates within PBP to assist the Super User with data entry.

DEDUCTIBLE

Initial specified dollar amount required to be paid by enrollee for a service category.

DEDUCTIBLE (MEDICARE)

The amount you must pay for health care before Medicare begins to pay, either for each benefit period for Part A, or each year for Part B. These amounts can change every year. (See Benefit Period; Medicare Part A; Medicare Part B.)

DEDUCTIBLES (MEDIGAP POLICY)

The amount you must pay for health care, before Medicare or some Medigap policies begin to pay. Some Medicare deductibles can change every year. (See Medigap Policy.)

DEFICIENCY (NURSING HOME)

A finding that a nursing home failed to meet one or more federal or state requirements.

DEHYDRATION

A serious condition where your body's loss of fluid is more than your body's intake of fluid.

DIABETIC DURABLE MEDICAL EQUIPMENT

Purchased or rented ambulatory items, such a glucose meters and insulin infusion pumps, prescribed by a health care provider for use in managing a patient's diabetes, as covered by Medicare.

DIAGNOSIS

The name for the health problem that you have.

DIAGNOSIS-RELATED GROUPS

A way to pay hospitals for health care based on diagnosis, age, gender, and complications.

DICTIONARY

A system database that drives the data entry variables and screens.

DIETHYLSTILBESTROL (DES)

A drug given to pregnant women from the early 1940s until 1971 to help with common problems during pregnancy. The drug has been linked to cancer of the cervix or vagina in women whose mother took the drug while pregnant.

DISCHARGE PLANNING

A process used to decide what a patient needs for a smooth move from one level of care to another. This is done by a social worker or other health care professional. It includes moves from a hospital to a nursing home or to home care. Discharge planning may also include the services of home health agencies to help with the patient's home care.

DISENROLL

Ending your health care coverage with a health plan.

DRUG TIERS

Drug tiers are definable by the plan. The option “tier” was introduced in the PBP to allow plans the ability to group different drug types together (i.e., Generic, Brand, Preferred Brand). In this regard, tiers could be used to describe drug groups that are based on classes of drugs. If the “tier” option is utilized, plans should provide further clarification on the drug type(s) covered under the tier in the PBP notes section(s). This option was designed to afford users additional flexibility in defining the prescription drug benefit.

DUAL ELIGIBLES

Persons who are entitled to Medicare (Part A and/or Part B) and who are also eligible for Medicaid.

DURABLE MEDICAL EQUIPMENT (DME)

Medical equipment that is ordered by a doctor for use in the home. These items must be reuseable, such as walkers, wheelchairs, or hospital beds. DME is paid for under Medicare Part B and Part A for home health services.

DURABLE MEDICAL EQUIPMENT REGIONAL CARRIER (DMERC)

A private company that contracts with Medicare to pay bills for durable medical equipment.

*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.

This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations,and rulings.
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Date Last Updated: September 23, 2004

 

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