Glossary: C

CAHPS
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) program is a public-private initiative to develop standardized surveys of patients” experiences with ambulatory and facility-level care. For more information, see the Agency for Healthcare Research and Quality website: https://www.cahps.ahrq.gov/default.asp
Capitation rate
contract between an insurer and provider which specifies total payment for services over a period of time
Capitation rate
the maximum amount an insurer will pay for a specific medical service under a capitation agreement
Carrier
any entity engaged in the business of underwriting insurance
Case manager
person responsible for coordinating the treatment plans and health service providers for a patient
Centers for Medicare and Medicaid Services (CMS)
Previously known as the Health Care Financing Administration (HCFA), CMS is the agency responsible for the administration of Medicare and Medicaid programs.
CHAMPUS
medical insurance for active duty and retired members of the armed services and their families (TRICARE)
Claim
provider or beneficiary’s written or electronic request for payment of medical services rendered
COBRA
Consolidated Omnibus Budget Reconciliation Act, legally requires employers to offer continued medical insurance coverage under a group health plan after termination or reduction in work hours.
Cognitive Impairment
impairment of a person’s intelligence, judgment, learning, and memory to the extent of requiring supervision to preserve safety
Coinsurance
the amount, usually a percentage, of out of pocket expenses you will have to pay after you have met all deductibles and your insurance has finalized a claim
Comprehensive Outpatient Rehabilitation Facility
multi-disciplinary outpatient facility providing rehabilitations services under the supervision of a physician
Concurrent review
review by certified personnel of continuing inpatient stays to assess medical necessity
Coordination of Benefits
the determination of whether an insurer pays a claim as primary, secondary, or tertiary
Coordination of Benefits Period
thirty month period from the time of eligibility due to ESRD that a Medicare beneficiary’s employer or union health plan must be the primary payer before Medicare
Copayment
a fixed out of pocket expense that you are required to pay for certain services such as inpatient stays, doctor visits, prescriptions,and emergency services
Covered services
services eligible for payment under an insurance policy
Crossover patient
patient covered by Medicare and Medicaid insurance
Current Procedural Terminology
procedure for reporting medical services that assigns five digit codes to healthcare procedures and updated annually by the American Medical Association
Custodial Care
Non-clinical services to assist with activities of daily living,not generally covered by Medicare

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