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Glossary of Billing Terms


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F

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Federal Tax ID Number - A number assigned by the federal government to doctors and hospitals for tax purposes.

Financial Responsibility
- How much of your bill you have to pay.

Fiscal Intermediary (FI) - A Medicare agent that processes Medicare claims.

Fraud and Abuse - Fraud: To purposely bill for services that were never given or to bill for a service that has a higher reimbursement than the service produced. Abuse: Payment for items or services that are billed by mistake by providers, but should not be paid for by the insurance plan. This is not the same as fraud.*

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G



Guarantor - Someone who has agreed to pay the bill.

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H



HCFA 1500 Billing Form (CMS) - A form used by doctors to file insurance claims for medical services.

HCPC Codes - A coding system used to describe what treatment or services were given to you by your doctor.

Health Care Financing Administration (HCFA) - Former name of the government agency now called the Centers for Medicare & Medicaid Services.

Healthcare Provider - Someone who provides medical services, such as doctors, hospitals, or laboratories. This term should not be confused with insurance companies that "provide" insurance.

Health Insurance
- Coverage that pays benefits for sickness or injury. It includes insurance for accidents, medical expenses, disabilities, or accidental death and dismemberment.

Health Maintenance Organization (HMO) - An insurance plan that pays for preventive and other medical services provided by a specific group of participating providers.

HIPAA - Health Insurance Portability and Accountability Act. This federal act sets standards for protecting the privacy of your health information.

Home Health Agency - An agency that treats patients in their homes.

Hospice - Group that offers inpatient, outpatient, and home healthcare for terminally ill patients.

Hospital Inpatient Prospective Payment System (PPS) - A federal system that pays a fixed fee for inpatient care.

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I



Incremental Nursing Charge - Charges for nursing services added to basic room and board charges.

Inpatient (IP) - Patients who stay overnight in the hospital.

Insurance Company Name - Name of the company that your claim will be sent to.

Insured Group Name - Name of the group or insurance plan that insures you, usually an employer.

Insured Group Number - A number that your insurance company uses to identify the group under which you are insured.

Insured's Name (Beneficiary) - The name of the insured person.

Intensive Care - Medical or surgical care unit in a hospital that provides care for patients who need more care than a general medical or surgical unit can give.

Internal Control Number (ICN) - A number assigned to your bill by your insurance company or their agent.

International Classification of Diseases, 9th Edition (ICD-9-CM) - A coding system used to describe what treatment or services your doctor gave to you.

IV Therapy - Treatment provided by giving intravenous solutions or drugs.

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NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is taken from the Medicare Glossary, http://www.medicare.gov, February 2003