Learn Medical billing terms - Education

Outpatient Hospital Services

Medically-necessary preventative, diagnostic, therapeutic, rehabilitative, or palliative services provided to an outpatient, by or under the direction of a physician or dentist, by an institution that is licensed as a hospital.

Patient Responsibility

The portion of a Medicaid recipient’s monthly income that is paid to the nursing facility.

Physician A doctor of medicine who holds a valid and active license in full force and effect pursuant to the provisions

Physician Services Medical care rendered by a physician, licensed to practice in the state where the service
is provided, and provided within the scope of practice of medicine as defined by state law.

POS Place of service or point of sale

Post Authorization The approval to bill Medicaid for medical or allied care, goods, or services obtained by a provider from the agency, or from a provider under contract with the agency to manage a client’s care, after the care, goods, or services have been furnished.

Provider Service Network (PSN)
A Provider Service Network (PSN) is an integrated health care delivery system owned and operated by Florida hospitals and physician groups. The PSN is a Medicaid managed-care option for Medicaid recipients in Miami- Dade and Broward counties, in addition to HMOs, MediPass, and the CMS Network. The South Florida Community Care Network (SFCCN) PSN is composed of the Public Health Trust of Miami-Dade County (PHT), Memorial Healthcare System (MHS), and the North Broward Hospital District (NBHD).
SFCCN enrollees receive the majority of their health care through the PSN.

Prior Authorization A request submitted to the fiscal agent, Medicaid, or a peer review organization for permission to perform one or more specific procedures.

Procedure Code A number that Medicaid uses to identify the procedures that providers render to Medicaid recipients.

Prosthetic Device A prosthetic device is a device or appliance to replace all or part of the function of a permanently inoperative or malfunctioning body part.

Provider Person or facility providing Medicaid services to recipients.

Psychiatrist A state licensed physician who is certified by the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry, or has completed a psychiatry residency accredited by the Accreditation Council for Graduate Medical Education or the Royal College of
Physicians and Surgeons of Canada.

Recipient A person who is eligible to receive services under Medicaid.

Share of Cost A share of cost is the amount of expenses that must be deducted from a Medically Needy recipient’s income to make him eligible for Medicaid.

Screening A medical examination provided to Medicaid patients designed to detect physical and mental conditions for the provision of treatment and other corrective health measures.

Service Authorization
The approval required from a designated authority for reimbursement for certain Medicaid services.

Service Limit Restriction on the maximum amount, duration or scope of a Medicaid covered service.

Specialty Hospital Any facility that meets the provisions specified in section 395.002, F.S., under the definition of hospital as included in this glossary. A specialty hospital regularly makes available either:
• The range of medical services offered by general hospitals, but restricted to a defined age or gender group of population; or
• A restricted range of services appropriate to the diagnosis, care, and treatment of patients with specific categories of medical or psychiatric illnesses or disorders.

TCN The Transaction Control Number (TCN) is an internal control number assigned to each claim as it is received by the fiscal agent for processing.

Third Party An individual, entity, or program, excluding Medicaid, that is, may be, could be, should be, or has been liable for all or part of the cost of medical services related to any medical assistance covered by Medicaid.


TOS Type of service Total Parenteral

Nutrition (TPN)
An intravenous solution providing complete nutritional needs, including lipids and amino acids, for recipients unable to receive nutrition via the gastrointestinal track.

TPL Third party liability refers to any entity other than the recipient (or his responsible party), that is liable to pay all or part of the cost of medical care

Urgent Services Those services needed to immediately relieve pain or distress for medical problems such as injuries, nausea, and fever; and services needed to treat infectious diseases and other similar conditions.

Visit A clinical staff and recipient face-to-face contact at the center, office, hospital, home or other place of service.

Void A negation of an original payment.

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