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To look up a health care term such as Actuary, choose the letter that the term begins with below under Alphabetical Glossary. This will take you to the terms beginning with that letter. To look up a health care acronym such as AIDS, choose the letter that the term begins with below under Acronyms. This will take you to all acronyms that begin with that letter.

M/R Coder	Responsible for assigning diagnostic and procedure codes to the records of discharged patients and forwarding reports to insurance and governmental review boards as required. The coder also records and determines other required data such as attending physician, use of intensive care unit, number of consultations and referral source and requests diagnoses from physicians when not recorded.
Maintenance of Benefits (MOB)	Variation of coordination of benefits that allows benefits only up to a maximum allowed had the enrollee been covered only under one health plan. This approach subtracts charges paid by the primary plan from total eligible expenses, then applies the secondary plan benefits to the remaining costs. Also see coordination of benefits.
Magnetic Resonance Imaging (MRI)	A diagnostic technique that uses radio and magnetic waves, rather than radiation, to create images of body tissue and to monitor body chemistry.
Mail Order Pharmacy	A source for brand name and generic prescription and over-the-counter medicines by mail, usually at lower unit prices than a retail pharmacy.
Major Diagnostic Category (MDC)	A clinically coherent grouping of ICD-9-CM diagnoses by major organ system or etiology that is used as the first step in assignment of most diagnosis related groups (DRGs). MDCs are commonly used for aggregated DRG reporting.
Malpractice	A dereliction from professional duty or a failure to exercise an accepted degree of professional skill or learning by one (as a physician) rendering professional services which results in injury, loss, or damage. Also an injurious, negligent, or improper practice.
Malpractice Insurance	Insurance purchased by doctors and other providers to cover them against malpractice lawsuits.
Managed Care	Organized programs designed to control access to impatient and ambulatory health services, to ensure the medical necessity of the proposed service and the delivery of the service at the most efficient and cost effective level of care consistent with high quality. Managed care is essential to the structure of alternative delivery and financing systems, such as health maintenance organizations and preferred provider arrangements. The requirements can also be a component of traditional indemnity or fee-for-service health coverage. Managed care may include pre-admission or pre-treatment certification, second surgical opinion programs, fee or price negotiation, pre-treatment protocol review, pre-admission testing, continued stay review, discharge planning, and individual/large case management. Failure to comply with managed care requirements or decisions usually reduces health benefit coverage for claims. The penalties may affect both the patient and the provider(s).
Managed Care Organization (MCO)	An entity which provides or contracts for managed care.
Managed Competition	A series of financial structures and methods used to manage the process by which individuals select health insurance coverage in a competitive market. The goal of managed competition is to encourage cost-conscious consumer choice when individuals select a plan. This, in turn, is intended to strengthen financial incentives for plans to deliver services in the most cost-effective manner. The basic structures of managed competition include a national board which would make decisions affecting benefit design and market rules, "sponsors" which manage the process of individual health insurance choice, and integrated health care delivery networks which provide and manage care. These structures have been termed as a National Health Board, Health Insurance Purchasing Cooperative (HIPCs), and Accountable Health Partnerships (AHPs) in several reform proposals.
Managed Fee-For-Service	An insurance plan that works very much like normal plans except they have specific enforced utilization rules which include, but are not limited to: pre-hospitalization case review, prospective length of stay approvals, second opinions for surgery, current and previous records review, discharge planning and claims audits.
Managed Health Care	See Managed Care.
Managed Health Care Plan	One or more products which (1) integrate financing and management with the delivery of health care services to an enrolled population; (2) employ or contract with an organized provider network which delivers services; (3) between a network or individual provider shares financial risk or has some incentive to deliver quality, cost-effective services; and (4) use an information system capable of monitoring and evaluating patterns of enrollees' use of services and the cost of those services. See health maintenance organization, preferred provider organization, exclusive provider organization, prepaid health plan, and primary care case management.
Management Guidelines	A practice guideline that covers the evaluation and management of patients who is known to have a particular condition.
Management Services Organization (MSO)	See administrative services organization.
Mandated Benefits	Each state is responsible for the conduct of the insurance business within its boundaries rather than the Federal Government. Each state establishes its requirements for insurance company licensure. A state may establish minimum health insurance policy coverage provisions, such as a specified scope of services and covered providers. A state may require that all insured benefit plans include specific benefits, or both approaches may be used, depending upon the specific coverage under consideration. ERISA exempts self-insured employers from state mandates.
Mandated Benefits, Federal Preemption	A legislative proposal that would require all employers to provide a minimum health benefit for all permanent employees as a condition of doing business. It would exempt employers meeting the Federal requirements from state mandated benefits.
Mandated Employer Insurance	Employers are required to provide health benefit coverage for their employees.
Mandated Providers	See essential community providers.
Manual Rates	Rates developed based upon the health plan's average claims data and then adjusted for group specific demographics, industry factors, or benefit variations.
Market Area	The targeted geographic area or areas of greatest market potential.
Market-Based Reform	Reliance on competition in the health care market to assure services of acceptable cost and quality to consumers without government mandates or involvement in rate-setting, financing, or administration. Can also refer to the reduction of barriers in the operation of a health care market.
Market Penetration	The part of the total health care market that a managed care company has captured.
Market Share	See market penetration.
Marketplace Medicine	An attempt by purchasers to introduce competition for patients among providers and professionals as a cost containment mechanism.
Match Certain Grants	Requirement that the grantee contribute a percentage of the resources necessary for carrying out the grant program. The usual resource is cash (hard match), but some programs accept personal and/or facilities in lieu of cash (soft match). Also see in-kind resources.
Material Safety Data Sheet (MSDS)	The purpose of OSHA Hazard Communication Standard is to ensure the hazards of all chemical substances and mixtures produced or imported are evaluated and this hazard information is communicated by means of a printed written document called the MSDS. The MSDS must be written in English and contain certain required information including the chemical identity or common name, health hazards, emergency & first aid procedures, and safety precautions.
Maternity-Stay Legislation	Governs the length of hospital stay for a mother and newborn following the newborn's birth. Most maternity-stay legislation follows guidelines jointly established by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) which recommend that a woman and newborn receive a minimum of 48 hours of hospital care following an uncomplicated vaginal delivery and 96 hours of care following a C-section.
Maximum Allowable Charge	The largest dollar amount to which an insurance carrier will apply plan benefits.
Maximum Allowable Costs List (MAC)	A list of prescription medications established by the health plan and distributed to pharmacies, which will be covered at a generic product level.
Maximum Out Of Pocket Costs	A limit on the total amount of co-payments, deductibles and co-insurance that a beneficiary is responsible for paying.
Medicaid (Title XIX)	A joint Federal-State program that pays for medical and other services on behalf of certain groups of low-income persons. See Social Security Act,categorically needy, medically needy, and Medicaid waivers. The following provisions of the Social Security Act relate to managed care and long term care: 1902( r)(2) - Section of the Social Security Act which allows states to use more liberal income and resource methodologies than those used in determining SSI eligibility as the basis for setting Medicaid eligibility. 1903(m) - Section of the Social Security Act which allows State Medicaid programs to develop risk contracts with HMOs or comparable entities. 1929 - Section of the Social Security Act which allows states to provide a broad range of Home and Community Care to functionally disabled individuals as an optional State plan benefit (unpopular because of caps on Federal participation).
Medicaid Management Information System (MMIS)	The reporting system used by HCFA to gather data on Medicaid use around the country. Can also refer to state or local Medicaid information systems.
Medicaid Waivers	An exception to the usual requirements of Medicaid granted to a state by HCFA. The following numbers refer to the applicable section of the Social Security Act: 1115 - Allows states to waive provisions of Medicaid law to test new concepts which are consistent with the goals of the Medicaid program. System-wide changes are possible under this provision. Frequently used to establish Medicaid managed care programs. 1915(b) - Allows state to waive freedom of choice. States may require that beneficiaries enroll in HMOs or other managed care programs, or select a physician to serve as their primary care case manager. 1915( c) - Allows states to waive various Medicaid requirements to establish alternative, community-based services for (a) individuals who would otherwise require the level of care provided in a hospital or skilled nursing facility, and/or (b) persons already in such facilities who need assistance returning to the community. Target populations for 1915( c) waivers include older adults, persons with disabilities, persons with mental retardation, persons with chronic mental illness and persons with AIDS. Also known as a 2176 waiver in reference to the relevant section of the Omnibus Budget Reconciliation Act of 1981. 1915(d) - Similar to 1915( c) waiver except that expenditures for nursing facility and home and community-based services for person 65 years and older cannot exceed a projected amount, determined by taking a base year expenditure (last year before the waiver), and adjusting for inflation. Also eliminates requirements that programs be statewide and be comparable for all target populations. Income rules for eligibility can also be waived.
Medicaid Prudent Pharmaceutical Purchasing Act (MPPPA)	Enacted as part of the Omnibus Budget Reconciliation Act of 1990, MPPPA provides that Medicaid must receive the best discounted price of any institutional purchaser of pharmaceuticals. In doing so, drug companies provide rebates to Medicaid equal to the difference between the discounted price and the price at which the drug was sold. This bill has resulted in cost shifting throughout the health industry.
Medical Aid Unit	A medical facility where ambulatory patients can be treated without an appointment, and receive immediate, non-emergency care. The medical aid units are not usually opened 24 hours a day; patients calling an HMO after hours with urgent, but not emergent, clinical problems, are often referred to these facilities.  A similar facility is an Urgent Care Center or Unit, which may be opened 24 hours a day.
Medical Care Evaluation Studies (MCE)	The name given to a generic form of health care review in which problems in the quality of the delivery and organization of health care services are addressed and monitored.
Medical Consumer Price Index	An inflationary statistic that measures the cost of all purchased health care services.
Medical Doctor (MD)	A licensed physician who is a graduate of an accredited medical school and practices allopathic medicine.
Medical Foundations (MF)	An organization through which physicians, hospitals and other providers can integrate the delivery of medical service. Usually an MF is an affiliate of a hospital through a common parent organization or is a subsidiary of a hospital. In most cases MFs are non-profit entities that own and manages facilities, equipment and supplies of a medical practice. They usually contract directly with patients and third party payers and employ non-professional personnel as well as physicians.
Medical Indigence	Inability to pay for needed medical care, whether through insurance, savings, current income, or borrowing against future income.
Medical IRA	A tax-exempt account into which each household would contribute a limited amount of money to cover medical costs or buy insurance.
Medical Laboratory Technician	Works under the direction of a registered medical laboratory technologist and performs many routine clinical laboratory procedures. These procedures include obtaining specimens, mounting tissue specimens and setting up and utilizing laboratory equipment.
Medical Laboratory Technologist (ASCP)	Performs a variety of chemical, microscopic, and bacteriology tests and procedures and related duties, to obtain data for use in the diagnosis and treatment of disease.
Medical Loss Ratio	The cost ratio of health benefits used compared to revenue received. Calculated as total medical expenses/total revenue.
Medical Protocols	Medical protocols are the guidelines that physicians in the future may be required to follow in order to have an acceptable clinical outcome. The protocol would provide the caregiver with specific treatment options or steps when faced with a particular set of clinical symptoms or signs or laboratory data. Medical protocols would be designed through an accumulated database of clinical outcomes.
Medical Savings Account (MSA)	A method of financing health care by giving a tax advantage to individuals who establish and maintain personal accounts for health care purposes; similar to an Individual Retirement Account for retirement purposes. Also referred to as individual health care account.
Medical Services Organization (MSO)	See provider sponsored organization.
Medical Technology	Includes drugs, devices, techniques, and procedures used in delivering medical care and the support systems for that care. There are no accurate estimates of how much new technology contributes to health spending.
Medical Transcriptionist	Transcribes from dictating machine diagnostic work-ups, case histories, physicals, consultations, discharge summaries, and operations, using knowledge of medical terminology. Performs other routine clerical work.
Medical Underwriting	The evaluation process to determine whether the individuals or groups' health risk is acceptable. Individuals or groups may have to have their past experience or medical histories reviewed prior to coverage.
Medically Indigent	A category within the state medical assistance program that defines an individual who is unable to pay for his/her health care.
Medically Necessary	A service or treatment which is appropriate and consistent with diagnosis, and which, in accordance with accepted standards of practice in the medical community of the area in which the health services are rendered, could not have been omitted without adversely affecting the member's condition or the quality of medical care rendered.
Medically Needy	Optional component of the Medicaid program that allows states to offer Medicaid to persons who would otherwise be eligible, but whose incomes are too high. Such persons become eligible by spending a portion of their income each month on outstanding medical bills. See spend down, and categorically needy.
Medically Unnecessary Days (MUD)	A term used to describe that part of a stay in a facility deemed to be excessive to diagnose and treat a medical condition because the stay was either too long, or more appropriate care is available in a less costly or more efficient setting.
Medicare (Title XVIII)	Federal program that provides basic health care and limited long term care for retirees and certain disabled individuals without regard to income level. Beneficiaries must pay premiums, deductibles and coinsurance. See beneficiary, cost sharing, medically necessary, and medigap. Part A - Medicare hospital insurance that helps pay for medically necessary inpatient hospital care, and, after a hospital stay, and limited inpatient care in a skilled nursing facility, for limited home health care or hospice care. Part B - Medicare medical insurance that helps pay for medically necessary physician services, outpatient hospital services and supplies that are not covered by the hospital insurance. Part C - See Medicare + Choice.
Medicare + Choice	Also referred to as "Medicare Part C," a Medicare program under which eligible Medicare enrollees can elect to receive benefits through a managed care program that places providers at risk for those benefits.
Medicare Bonus Payment	An additional 10% payment to the physician above the allowed charge for services delivered to Medicare Beneficiaries in designated Health Professional Shortage Areas.
Medicare Cost HMO or Contract	Prospective payment for acute and primary health care (monthly fee per patient with settlement annually based on actual costs). Primarily used in rural areas where full capitation is not feasible.
Medicare Cost Report (MCR)	An annual report required of all institutions participating in the Medicare program. The MCR records each institution's total costs and charges associated with providing services to all patients, the portion of those costs and charges allocated to Medicare patients, and the Medicare payments received.
Medicare Insured Group (MIG)	Employer (or union) groups receiving a capitated rate from Medicare in exchange for integrating Medicare covered services into the employers own traditional retiree health plan.
Medicare Payment Advisory Commission (MedPAC)	A non-partisan congressional advisory body charged with providing policy advice and technical assistance concerning the Medicare program and other aspects of the health system. It conducts independent research, analyzes legislation, and makes recommendations to Congress. The Physician Payment Review Commission (PPRC) has been merged with the Prospective Payment Assessment Commission (ProPAC) to create MedPAC.
Medicare Provider Analysis and Review File (MedPAR)	A HCFA data file that contains charge data and clinical characteristics, such as diagnoses and procedures, for every hospital inpatient bill submitted to Medicare for payment.
Medicare Risk Contract	A contract between Medicareand a health plan under which the plan receives monthly capitated payments to provide Medicare-covered services for enrollees, and thereby assumes insurance risk for those enrollees. A plan is eligible for a risk contract if it is a Federally qualified HMO or a competitive medical plan.
Medicare Secondary Payer	See cost shifting, Medicare.
Medicare Select	A form of Medigap insurance that allows insurers to experiment with the provision of supplemental benefits through a network of providers. Coverage is often limited to those services furnished by the participating network providers and emergency out-of-area care.
Medicare Self Referral Option	A Medicare + Choice point of service option that allows enrollees in a Medicare risk HMO to go out of plan at a higher cost.
Medicare Supplement Policy	See medigap.
Medicare Waiver (222)	Section of the Social Security Amendments of 1972 allowing the Federal Government to waive Medicare payment rules and allow alternative payment methods including capitation.
Medigap	A policy guaranteeing to pay a Medicare beneficiary's co-insurance, deductible and co-payments and will provide additional health plan or non-Medicare coverage for services up to a predefined benefit limit. In essence, the product pays for the portion of the cost of services not covered by Medicare.
MedSupp	See Medigap.
Member	A participant in a health plan who makes up the plan's enrollment.
Member Month	A unit of volume measurement. A member month is equal to one member enrolled in an HMO for one month, whether or not the member actually receives any services during the period. Two member months are equal to one member enrolled for two months or two members enrolled for one month.
Members Per Year	The number of members effective in the health plan on a yearly basis.
Mid Level Practitioner	Group of health professionals with advanced health care training (including nurse practitioners and physician assistants) that can perform specialized health care tasks usually in support of, and under the supervision of, a physician.
Miller Trusts	Commonly known as income sheltering devices, these trusts enable otherwise income-ineligible Medicaidapplicants to qualify for Medicaid.
Minimum Benefits	See standard benefits package.
Minimum Data Sets (MDS)	Federal data collection system for assessing nursing home patients. The MDS for nursing facility residents is a comprehensive resident assessment instrument (RAI) that measures functional status, mental health status, and behavioral status to identify chronic care patient needs and formalize a care plan in response to 18 Resident Assessment Protocols (RAPs). Under Federal regulation, assessments are conducted at a time of admission into a nursing facility, upon return from a 72-hour hospital admission, whenever there is a significant change in status, quarterly, and annually, Also see resource utilization groups.
Minimum Premium	Financing mechanism for a medical benefit program in which an employer remits only a portion of the conventional premium to the insurer to cover the cost of administering the benefits program and to providing specific and aggregate stop-loss insurance. The employer funds a "bank account" which the insurer draws upon for payment of claims.
Minnesota Care	Minnesota's health care plan passed in April of 1992. This law is intended to provide health care to all of Minnesota's citizens while cutting health care costs. It includes cost-containment provisions for setting overall health care spending targets, monitoring providers, reviewing the distribution of new technologies, and evaluating methods for collecting health care data.
Mixed Model HMO	A health plan that includes more than one form of HMO within a single plan.
Modified Community Rating	A separate rating of medical service usage in a given geographic area using age-sex data.
Modified Fee-For-Service	A system in which providers are paid on a fee-for-service basis, with certain fee maximums for each procedure.
Moral Hazard	Tendency of an enrollee to use benefits unnecessarily unless given incentives (such as co-payments and deductibles) not to do so. Also see cost sharing.
Morbidity	Incidents of illness and accidents in a defined group of individuals.
Mortality	Incidents of death in a defined group of individuals.
Most-favored-nation clause	A provision requiring the contracting physician, hospital or group to provide an issuer with the lowest price it charges any other insurer.
Multiple Employer Welfare Arrangement	A group of employers joined together to offer employees health benefits comparable to traditional health insurance packages. Employers take part to reduce health insurance costs and spread the risk over a larger group of people.
Multiple Employer Trust	Legal trust established by a plan sponsor that brings together a number of small, unrelated employers for the purpose of providing group medical coverage on an insured or self-funded basis.
Multiple Option Plan	A health plan design that offers employees the option of electing to enroll under one of several types of coverage, usually from among an HMO, a PPO, and a major medical indemnity plan.
Multipurpose Senior Center	A community or neighborhood facility established for the organization and provision of a broad spectrum of supportive services, including health, social, nutritional, and educational services, and the provision of facilities for recreational activities for older individuals.
Multispecialty Group	A group of doctors who represent various medical specialties and who work together in a group practice.