Confused by the proliferation of heathcare terms and acronyms? The information below will help you decipher the meaning of various homecare terms.
(ABN) Advance Beneficiary Notice
Approved amount: The fee Medicare sets as reasonable for a covered medical service. It may be less than the actual amount charged. Approved amount is sometimes called "approved charge."
(CMS) Centers for Medicare & Medicaid Services: The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Program, and works to make sure that the beneficiaries in these programs have access to high quality health care.
(CBA) Competitive Bidding Area
(CBIC) Competitive Bidding Implementation Contractor
(HHS) Departnment of Health and Human Services
(DME) Durable Medical Equipment: Medical equipment that is ordered by a doctor for use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds.
(DME MAC) Durable Medical Equipment Medicare Administrative Contractor
(DMEPOS) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
(DMERC) Durable Medical Equipment Regional Carrier
(FFS) Fee For Service
(HCPCS) Healthcare Common Procedure Coding System
(HIPPA) Health Insurance Portability and Accountability Act of 1996
Homebound: Normally unable to leave home. Leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for nonmedical reasons, such as a trip to the barber.
Home Health Agency: An organization that provides homecare services, including skilled nursing care, physical therapy, occupational therapy, speech therapy, and care by home health aides.
Home Health Care: Skilled nursing care and certain other health care that you get in your home for the treatment of an illness or injury.
Medically Necessary: Services or supplies that:
are proper and needed for the diagnosis, or treatment of your medical condition;
are provided for the diagnosis, direct care, and treatment of your medical condition;
meet the standards of good medical practice in the medical community of your local area; and
are not mainly for the convenience of you or your doctor.
Medicaid: A joint Federal and State program that helps with medical costs for some people with low incomes. Programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.
Medicare: A health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with permanent kidney failure who need dialysis or a transplant (End-Stage Renal Disease [ESRD]).
(MSA) Metropolitan Statistical Area
(NSC) National Supplier Clearinghouse
(NPWT) Negative Pressure Wound Therapy
Out-of-Pocket Costs: Health care costs that you must pay on your own because they are not covered by Medicaid, Medicare, or private insurance.
(PAOC) Patient Advisory and Oversight Committee
Plan of Care: A plan written by your doctor that describes what kind of services and care you must receive for your health problem.
Provider: A doctor, hospital, health care professional, or health care facility.
Regional Home Health Intermediaries: A private company that contracts with Medicare to process claims and make checks of home health care.
(SNF) Skilled Nursing Facility
Skilled Nursing Care: A level of care that must be given or supervised by licensed nurses and is under the general direction of a doctor. All of your needs are taken care of with this type of service, including giving direct services. Examples of skilled nursing care are: getting intravenous injections, tube feeding, oxygen to help you breathe, and changing sterile dressings on a wound. Any service that could be safely performed by an average nonmedical person (or one's self) without the direct supervision of a licensed nurse is not covered.
(SADMERC) Statistical Analysis Durable Medical Equipment Regional Carrier
(SHIP) State Health Insurance Assistance Program: A state organization that receives money from the federal government to give free health insurance counseling and assistance to Medicare beneficiaries.