ACH
Automated Clearing House
AMA
American Medical Association
ARU
Automated Response Unit
Assignment
In the Original Medicare Plan, this means a doctor or supplier agrees to accept the Medicare-approved amount as full payment. If you are in the Original Medicare Plan, it can save you money if your doctor accepts assignment. You still pay your share of the cost of the doctor's visit.
Beneficiary
The name for a person who has health care insurance through the Medicare or Medicaid program.
BPI
Bytes Per Inch
CCD+
Cash Concentration/Disbursement Plus
CIA
Coverage Issues Addendum
CIM
Coverage Issues Manual
Co-Payment
In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a doctor’s visit, or prescription. A copayment is usually a set amount you pay. For example, this could be $10 or $20 for a doctor’s visit or prescription. Copayments are also used for some hospital outpatient services in the Original Medicare Plan
Coinsurance
The amount you may be required to pay for services after you pay any plan deductibles. In the Original Medicare Plan, this is a percentage (like 20%) of the Medicare approved amount. You have to pay this amount after you pay the deductible for Part A and/or Part B. In a Medicare Prescription Drug Plan, the coinsurance will vary depending on how much you have spent.
Coorindation of Benefits
Process for determining the respective responsibilities of two or more health plans that have some financial responsibility for a medical claim. Also called cross-over.
Deductible
The amount you must pay for health care or prescriptions, before Original Medicare, your prescription drug plan, or other insurance begins to pay. For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.
DHHS
Department of Health and Human Services
DME
Durable Medical Equipment
DMEPOS
Durable Medical Equipment Prosthetics, Orthotics and Supplies
DMERC
Durable Medical Equipment Regional Carrier
EFT
Electronic Funds Transfer
EIN
Employer Identification Number
EMC
Electronic Media Claim
ERN
Electronic Remittance Notice
HCFA
Health Care Financing Administration
HCPCS
HCFA Common Procedure Coding System
HI
Hospital Insurance Program (Part A)
HICN
Health Insurance Claim Number
HIPAA Health Insurance Portablilty & Accountability Act of 1966
Federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. Title II, Subtitle F, of HIPAA gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information. Also known as the Kennedy-Kassebaum Bill, the Kassebaum-Kennedy Bill, K2, or Public Law 104-191.
ICC
Individual Claim Consideration
MSP
Medicare Secondary Payor
NACHA
National Automated Clearing House Association
NOC
Not Otherwise Classified
NSC
National Supplier Clearinghouse
NSF
National Standard Format
OCHAMPUS
Office of Civilian Health & Medical Program of the Uniformed Services
OCNA
Other Carrier Name Address
SADMERC
Statistical Analysis DMERC
SMI
Supplementary Medical Insurance Program (Part B)
SSN
Social Security Number
Back to GlossariesBack to Top