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MMA 2003

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
REFERRAL

An OK from your primary care doctor for you to see a specialist or get certain services. In many Medicare managed care plans, you need to get a referral before you get care from anyone except your primary care doctor. If you do not get a referral first, the plan may not pay for your care. (See Emergency Care; Primary Care Doctor; Urgently Needed Care.)

REFERRAL

A plan may restrict certain health care services to an enrollee unless the enrollee receives a referral from a plan-approved caregiver, on paper, referring them to a specific place/person for the service. Generally, a referral is defined as an actual document obtained from a provider in order for the beneficiary to receive additional services.

REGIONAL HOME HEALTH INTERMEDIARY (RHHI)

A private company that contracts with Medicare to pay home health bills and check on the quality of home health care.

RESERVE DAYS

(See Lifetime Reserve Days.)

RESPITE CARE

Temporary or periodic care provided in a nursing home, assisted living residence, or other type of long-term care program so that the usual caregiver can rest or take some time off.

RESTRAINT

Any physical or chemical way to stop a patient from being free to move. These restraints are used to prevent patient injury and are not used for treating medical symptoms.

RISK ADJUSTMENT

The way that payments to health plans are changed to take into account a person's health status.

*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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