Medical billing information and Glossary

General Hospital
Any institution that regularly makes its facilities and services available to the general population. In accordance with the provisions specified as an establishment that offers:
• Services more intensive than those required for room, board, personal services and general nursing care;
• Facilities and beds for use beyond 24 hours by individuals requiring diagnosis, treatment, or care for illness, injury, deformity, infirmity, abnormality, disease, or pregnancy;
• And regularly make available:
a. clinical laboratory services
b. diagnostic x-ray services
c. treatment facilities for surgery or obstetrical care, and

d. other definitive medical treatment.

HCPCS Healthcare Common Procedure Coding System—the common procedure coding system that is used by health care providers to identify the services that the provider performed. This coding system is administered by the Centers for Medicare and Medicaid Services (CMS), formerly known as the
Health Care Financing Administration.

Health Care Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996. HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. HIPAA’s Administrative Simplification provisions require the Department of Health and Human Services (HHS) to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data.

Hospital A facility licensed in accordance with the provision of Chapter 395, Florida Statutes, or the applicable laws of the state in which the service is furnished.

ICD-9-CM A three volume set of books listing the international classification of diseases:
Volume 1 - Numeric listing of diagnosis codes
Volume 2 - Alphabetic listing of diagnosis codes
Volume 3 - Hospital surgical procedure codes

ICP Institutional Care Program – long term care.

Inpatient A person who has been admitted to a hospital for purposes of receiving inpatient hospital services with the expectation that he will remain at least overnight and occupy a bed even though it may later develop that he can be discharged or transferred to another hospital and does not actually use the
hospital bed overnight.

Inpatient Hospital Services
Services furnished in an institution maintained primarily for the care and treatment of patients with disorders other than mental diseases or substance abuse diagnoses (except that services aimed at medical stabilization or detoxification are covered if deemed medically necessary to be performed in the inpatient setting). These services are rendered under the direction of a physician or dentist.

Medical Care The provision of medically necessary procedures rendered in the course of diagnosis and treatment of an illness or injury.

Medical Supplies Medical or surgical items that are consumable, expendable, disposable or non-durable and that are used for the treatment or diagnosis of a patient’s specific illness, injury, or condition.

Medically Complex A person is medically complex if he has chronic debilitating diseases or conditions of one or more physiological or organ systems that make the person dependent upon 24-hour per day medical, nursing or health supervision or intervention.

Medically Fragile An individual who is medically complex and technologically dependent on medical apparatus or procedures to sustain life. Examples are individuals who require total parenteral nutrition, are ventilator dependent, or are dependent on a heightened level of medical supervision to sustain life, and
without such services are likely to expire without warning.

MediPass MediPass is a primary care, case-management program designed to assure Medicaid recipients access to care, decrease inappropriate service utilization, and control costs.

MIC Medicaid Identification Card

NDC National Drug Code

Neurological Services
Services covered under the branch of medicine that comprehends the diagnosis and treatment of disorders of the nervous system, which services are included in the Medicaid fee schedule.

Neurologist A state licensed physician who is certified or meets the requirements for certification as a neurologist by the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry.

New Patient A recipient that is new to the center, office, or provider or whose records are not normally available. For physicians, a new patient is one who has not received any professional services from a provider or another provider of thesame specialty who is in the same provider group, within the past three years.

Newborn An infant from birth through the first four weeks of life.

Non-participating Hospital
A hospital that has not signed an agreement with Florida Medicaid to participate in the Medicaid program. This type of hospital may only treat Medicaid recipients in cases of emergencies or when prior authorized
services have been arranged. The recipient must be discharged or transferred to a participating hospital once he or she has been stabilized.