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Managed care: A health care system that employs cost containment by limiting the reimbursement levels paid to providers or by reducing utilization in order to "manage" the cost, quality, and access to health care. Examples of managed care are Health maintenance organizations (HMOs) and Preferred provider organizations (PPOs).

Medi/Medi: Combined coverage between Medicare and Medicaid. Sometimes referred to as Care/Caid. When an individual falls under the category of Medi/Medi, Medicaid is the payer of last resort.

Medicaid: A joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Medical accounting software program: A software program, such as Medical Manager or MediSoft, that tracks patient information, appointment schedules, charges, payments, and other information necessary for accurate accounting records, through a series of menus through which the medical team enters data.

Medical underwriting: The process an application for medical insurance goes through to determine and/or identify existing health conditions of the applicant that may need further medical treatment now or in the future. There are usually several steps an application for health insurance must go through before it is approved, such as:

• Initial screening - where responses to all questions on the application are examined to make sure they have been fully and accurately answered and any necessary forms are attached.
• Medical underwriting - where a trained, medically knowledgeable professional carefully reviews the application, looking at the medical history and any previous claims that the applicant may have had that would impact future claims. Often additional information is needed to make a final decision.
• Medical underwriting decision - The medical underwriter makes a decision after receiving all pertinent and requested information whether or not the applicant qualifies (under individual carrier guidelines) for medical coverage.

Medically indigent: Individuals and their families who have too much income to qualify under Medicaid's mandatory or optional categorically needy groups but can qualify for certain funds due to their high level of medical expenses. This can be accomplished by "spending down" to Medicaid eligibility by incurring medical and/or remedial care expenses to offset excess income, thereby reducing it to a level below the maximum allowed by that state's Medicaid plan. Also known as "medically needy."

Medically needy: Individuals and their families who have too much income to qualify under Medicaid's mandatory or optional categorically needy groups but can qualify for certain funds due to their high level of medical expenses. This can be accomplished by "spending down" to Medicaid eligibility by incurring medical and/or remedial care expenses to offset excess income, thereby reducing it to a level below the maximum allowed by that state's Medicaid plan. Also known as "medically indigent."

Medically necessary: A term given to medical procedures or services that are performed only for the treatment of an accident, injury, or illness which are appropriate for the diagnosis and are not considered experimental, investigational, or cosmetic.

Medicare: The federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD).

Medicare approved amount: The fee Medicare sets as reasonable for a covered medical service. This is the amount a health care provider or supplier is paid by the patient and Medicare for a service or supply. It may be less than the actual amount charged by a doctor or supplier. The approved amount is sometimes called the "Approved Charge."

Medicare+Choice (Plan): A health plan, such as a Medicare managed care plan or Private Fee-for-Service plan offered by a private company and approved by Medicare. An alternative to the Original Medicare Plan.

Medicare remittance advice (MRA or RA): With every claim that is submitted to Medicare by the health care provider, Medicare creates an Explanation of benefits, also called a remittance advice (RA), which contains information that explains how a Medicare claim was processed.

Medicare remittance notice (MRN): (See Medicare remittance advice.)

Medicare Secondary Payer (MSP): A statutory requirement that private insurers providing general health insurance coverage to Medicare beneficiaries pay beneficiary claims as primary payers.

Medicare summary notice (MSN): A notice a patient receives after the health care provider files a claim for Part A and Part B services in the Original Medicare Plan. It explains what the provider billed for, the Medicare-approved amount, how much Medicare paid, and what you must pay. The patient might also receive a notice called an Explanation of Medicare Benefits (EOMB) for Part B services or a notice of utilization.

Medigap policy: A Medicare supplement insurance policy sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Except in Massachusetts, Minnesota and Wisconsin, there are 10 standardized plans labeled Plan A through Plan J. Medigap policies only work with the Original Medicare Plan.

Military treatment facility: A medical facility operated by one or more of the Uniformed Services. A Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Services (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF).

Modem: Modem is an acronym for Modulator Demodulator. A modem is a device that converts data from digital computer signals to analog signals that can be sent over a phone line. This is called modulation. The analog signals are then converted back into digital data by the receiving modem. This is called demodulation. A modem is fed digital information, in the form of ones and zeros, from the CPU. The modem then analyzes this information and converts it to analog signals that can be sent over a phone line. Another modem then receives these signals, converts them back into digital data, and sends the data to the receiving CPU.

Modifiers: The addition of one or two digits added to a code that allows for a more specified description of the service/procedure performed or the diagnosis assigned to the patient. For example, a modifier can describe a "bilateral" procedure or tell the claims processor that unusual circumstances beyond those normally associated with the code occurred.