Defining the Acronyms and Abbreviations

These are among the most commonly used Medicare managed care acronyms and abbreviations.

ACRONYM	MEANING	PURPOSE / DEFINITION
HCFA	Health Care Finance Administration	Responsible for administration and operation of the Medicare program
M + C	Medicare + Choice	The new Medicare program, effective 1/1/99
MCO	Managed Care Organization	A health plan that offers managed care products, typically a health maintenance organization
BBA 97	Balanced Budget Act of 1997	The legislative act which modified the Medicare program by giving Medicare recipients more choice, and enhancing quality improvement and monitoring functions
HEDIS	Health Plan Employer Data and Information Set	Sets minimum care standards used to evaluate the quality of health care provided
QISMC	Quality Improvement System for Managed Care	New system for measuring and improving the quality of care in Medicare managed care
QAPI	Quality Assessment and Performance Improvement	Contains clinical and non-clinical measures of the quality of care provided
CHAPS	Consumer Assessment of Health Plans Study	A survey that measures the satisfaction of Medicare managed care members with the Medicare HMO and provider
CHDR	Center for Health Dispute Resolution	The group responsible for the final resolution of Medicare managed care members’ complaints and grievances