Physician

Medically Necessary
Services or supplies that are proper and needed for the diagnosis or treatment of the
beneficiary’s medical condition;; furnished for the diagnosis, direct care, and treatment of
the beneficiary’s medical condition;; meet the standards of good medical practice;; and
are not mainly for the convenience of the beneficiary, provider, or supplier.
Medicare Administrative Contractor
All Medicare work performed by Fiscal Intermediaries, Carriers, and Durable Medical
Equipment Carriers will be replaced by these Centers for Medicare & Medicaid Services
Contractors by 2011, as mandated in Section 911 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003.
Medicare Advantage; Part C of the Medicare Program
A program through which organizations that contract with the Centers for Medicare &
Medicaid Services furnish or arrange for the provision of health care services to
Medicare beneficiaries (with the exception of individuals with End-Stage Renal Disease
who are generally excluded from enrolling in Medicare Advantage [MA] Plans) who are
entitled to Part A and enrolled in Part B, permanently reside in the service area of the
MA Plan, and elect to enroll in a MA Plan.
Medicare Economic Index
A measure of inflation faced by physicians with respect to their practice costs and
general wage levels.
Medicare Physician Fee Schedule
The basis for which Medicare Part B pays for physician services. It lists the more than
7,000 covered services and their payment rates.
Medicare Summary Notice
Notice that beneficiaries receive on a monthly basis that lists all services or supplies
that were billed to Medicare.
Medigap
A health insurance policy sold by private insurance companies to fill gaps in Original
Medicare Plan coverage.
N
National Coverage Determination
A coverage policy that sets forth the extent to which Medicare will cover specific
services, procedures, or technologies on a national basis.
Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 82