Healthcare Terms

HIPAA: HIPAA stands for Healthcare Insurance Accountability And Portability Act.

HMO: HMO Stands for Health Maintenance Organization. It offers prepaid comprehensive coverage for both hospital and physician services.

Medicare: It’s a Federal health insurance program for people of age 65 or older and for individuals with disabilities.

Medicaid: It is a program sponsored by the federal government and administered by states and is intended to provide health care and health related services to low income individuals.

CMS: CMS is the Centers for Medicare & Medicaid Services.It is the federal agency responsible for administering the Medicare, Medicaid, SCHIP (State Children's Health Insurance), HIPAA(Health Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and several other health-related programs.

EDI: It stands for Electronic Data Interchange. It’s the mutual exchange of healthcare data between the providers and insurance company.

EOB: EOB stands for Explanation Of Benefits. It details the results of processing a claim. Provider receives a remittance advice or remit, which is a notice sent by the insurance company that contains payment information about a claim.

Coding: It’s the process of assigning diagnoses, procedures, and services using numeric and alphanumeric characters. Two coding systems are used in healthcare: ICD-9-CM (International classification of disease) and HCPCS (Healthcare Common Procedure Coding System).

HIPDB: Its Healthcare Integrity and Protection Data Bank which combats fraud and abuse in health insurance and health care delivery.

HCRA: HealthCare Reimbursement Account, a tax exempt account used to pay for healthcare expenses.

MEVS: Medicaid Eligibility Verification System. It allows provider’s to electronically access the state’s eligibility file.

NPI: Stands for National Provide Identifier. Its purpose is to uniquely identify a healthcare provider in standard transactions, such as healthcare claims.

HHS: The Department of Health and Human Services (HHS) has determined that CMS will have responsibility for enforcing the transactions and code set standards, as well as security and identifiers standards when those are published. CMS will also continue to enforce the insurance portability requirements under Title I of HIPAA. The Office for Civil Rights in HHS will enforce the privacy standards.

COB: Coordination of Benefits.

EFT: Electronic Fund Transfer

LR: Legislative request

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