OVERVIEW OF US HEALTHCARE
The Health Care Financing Administration (HCFA), created on March 9, 1977, to consolidate the administration of the largest Federal health programs, Medicare and Medicaid, was named the Centers for Medicare & Medicaid Services (CMS) on June 14, 2001.
In 1965, the Social Security Act established both Medicare and Medicaid. Medicare was a responsibility of the Social Security Administration (SSA), while Federal assistance to the State Medicaid programs was administered by the Social and Rehabilitation Service (SRS). SSA and SRS were agencies in the Department of Health, Education, and Welfare (HEW). In 1977, the Health Care Financing Administration was created under HEW to effectively coordinate Medicare and Medicaid. In 1980 HEW was divided into the Department of Education and the Department of Health and Human Services (HHS).
Medicare extended health coverage to almost all Americans aged 65 or older. About 19 million beneficiaries enrolled in Medicare in the first year of the program. Medicaid provided access to health care services for certain low-income persons and expanded the existing Federal-State welfare structure that assisted the poor. Medicare is a Health
Insurance Program for people 65 years of age and older, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).
Medical Insurance Programs in the United States
The US healthcare industry is widespread and covers most of its population. The term health insurance refers to a wide variety of insurance policies. These range from policies that cover the costs of doctors and hospitals to those that meet a specific need, such as paying for long-term care.
But when people talk about health insurance, they usually mean the kind of insurance offered by employers to employees, the kind that covers medical bills, surgery, and hospital expenses. We have heard this kind of health insurance referred to as comprehensive or major medical policies, alluding to the broad protection they offer. But the fact is, neither of these terms is particularly helpful to the consumer.
Today, when people talk about broad health care coverage, instead of using the term "major medical," they are more likely to refer to fee-for-service or managed care. These terms apply to different kinds of coverage or health plans. These are specific kinds of managed care plans: health maintenance organizations or HMOs, preferred provider organizations or PPOs, and point-of-service or POS plans.
While fee-for-service and managed care plans differ in important ways, in some ways they are similar. Both cover an array of medical, surgical, and hospital expenses. Most offer some coverage for prescription drugs, and some include coverage for dentists and other providers. But there are many important differences that will make one or the other form the different type of coverage’s to choose. HCFA 1500 or HCFA 1450(UB92) Forms
These are the electronic or hard copy formats in which a claim is sent to insurance company.
HCFA 1500
Physicians in order to communicate the services that were performed to the insurance company and the carrier’s to understand what services were provided, HCFA has provided a form called HCFA 1500.
Most Insurance companies request the billing office to submit their claims in HCFA 1500 form. HCFA 1500 form is commonly used to report physician services.
HCFA 1500 contains information as mentioned below: -
Type of Insurance, Insured’s ID number, Patient’s name, Patient’s date of birth and sex, Insured’s name, Patient’s address, Patient’s relationship to insured, Insured’s address, Patient status, Other Insured’s name, Other Insured’s Policy or group number, other insured’s date of birth and sex, employer’s name, Insurance plan name, patients condition related to employment, Patient’s condition related to auto accident, patient condition related to other accident, Insured’s policy or group number, Insured’s date of birth, Patient’s or authorized person’s signature, Insured’s or authorized signature, date of current illness, similar illness, dates patient unable to work in current employment, name of referring physician, ID number of referring physician, Hospitalization dates related to
current services, outside lab, diagnosis, Medicaid resubmission code, prior authorization number, date of service, place of service, type of service, procedures, diagnosis code, charges, units, COB, Federal Tax ID number, patient’s account number, accept assignment, Total charge, Amount paid, Balance due, signature of physician or supplier, name and address of facility where services were rendered, physician’s supplier’s billing name and address with phone number.
HCFA 1450 or UB92 Form
Facilities in order to communicate the services that were performed to the insurance company and the carrier’s to understand what services were provided, HCFA has provided a form called HCFA 1450 or UB92 form.
HCFA 1450 or UB92 form has more elaborate information then HCFA 1500. In addition to HCFA 1500 form UB92 or HCFA 1450 contains the following information.
Type of Bill, Revenue code, date of injury, HCPCS level 1 and HCPCS level 2 or 3 codes can be mentioned on the same claim as per the carrier’s requirements.
Paper Claims
Claims forwarded through U.S. Postal Service are called Paper Claims. Claims that are not forwarded electronically are sent through Postal Service.
Claims department are responsible for printing these claims and also they need to ensure that all the fields in the HCFA 1500 or 1450 are filled as per each carrier’s requirements.
Printing these claims and dispatching them from the billing office to the respective insurance companies are the basic task of claims department.
Explanation of Benefits
A form included with a check from the insurance carrier, which explains the benefits that were paid and/or charges that were rejected.
Explanation of benefits clearly indicates the Physician or Facility name, patient name details of payment or denial etc.
Explanation of Benefit is also a confirmation of claims received by the carrier. Carriers communicate regarding the claims sent only through this explanation of benefits.
Factors involved in a Billing Cycle
Patients:
Persons who are beneficiaries in respect of the various insurance plans for health care and undergo consult /treatment with the physician are termed as ‘Patients ‘. Patients derive the attention of the insurance companies, doctor and the billing office.
Most of the patients are enrolled with Insurance Companies in order to get their health care expenses covered. These patients pay monthly premiums to the Insurance companies to be eligible for their coverage. Medical Insurance in the US is negotiated as a part of the salary. The medical insurance companies provide for a variety of regular health check- up and routines and also provide for the reimbursement of ‘medically necessary ‘and eligible services.
All documents pertaining to the patients should be maintained with high confidentiality in the doctor’s offices and billing offices. Billing offices free up the valuable physician time by offering to outsource billing activity and allow them to have an enhanced focus on their patients.
Physicians & Hospitals:
Physicians & Hospitals are the healthcare providers for the patients. Providing perfect healthcare to the patients is the fundamental role of agencies irrespective of costs / profit motive. Perfect diagnosis and treatment are the aim and goals of the healthcare providers.
Physicians and hospitals are supposed to sign up with insurance companies and offer to treat the patients within the respective policy guidelines. They also agree to treat the patient and submit the bill to the insurance companies without charging any amount (to the patient) towards cost of submission of bills. At any given point of time the physician is supposed to only obtain the deductible portion payable by the patient in advance as per the policy terms of insurance companies. Further the physician needs to bill the amount indicated by the insurance company as Patients responsibility to the patients.
Billing Office
Billing Office in the United States is basically an accounting and finance bill processing office. This office offers a variety of services to physicians by picking up their work of submission of bills, follow up for payment, up to the final stage of obtainment of reimbursement for physicians services. An office, which provides complete services of coding, maintaining patient’s records & accounts, filing claims to insurance companies, following up with the insurance companies and patients, thereby assuring high productivity in less turn around time and reimbursement with strict adherence to rules and laws of insurance companies is called a Billing Office.
Clearing House
An office, which receives the claims from billing office, doctor’s office or hospitals in ASCII (American Standard code for information interchange) text format and transmits them directly to the respective insurance company via tapes, discs or modem after validation using EBCDIC (Extended Binary Code Digital Interchange Code) format is called a Clearing House.
All the claims are sent in ASCII text formats from the billing office to the clearing-house and from the clearing-house the claims are forwarded to its destinations in a format acceptable to the insurance companies. Some of the major clearinghouses are Fast Claims and Halley Exchange.
Insurance Companies
Insurance Companies are organizations that deal with Health insurance through regular health insurance plans ands are established in accordance with the Federal law. The various insurance companies in the US include Medicare, Medicaid, Blue Cross Blue Shield, UHSC (U.S. Health Care), Guardian AETNA and Keystone.
Patient’s Contract & Eligibility
An individual signs up with an insurance company choosing a plan or benefit program to cover his and his family health care requirements either on his own or through his employer thereby covering all the Medical expenses and physicians fees including hospital stays, lab services and preventive services.
The above plan or policy opted out would involve payment of monthly premium towards the health care policy, in certain cases the health care provided is free of premium payment. Individuals may opt out for certain plans and the respective benefits are assigned based on the plans. Individuals may opt to sign up for an individual policy or a group policy (involves, family policy)
Medicare is a program enacted by Congress in August 1965 to provide hospital and medical insurance benefits to the elderly (over 65) and disabled.
When an individual attains the age of 65 and is eligible for social security retirement or survivor benefits or railroad retirement benefits are eligible for Medicare, also persons under age 65 if they are entitled to social security (or railroad retirement) disability benefits or to those who have end stage renal disease are eligible for Medicare.
All inpatient hospital and home health care covered by Medicare is called Medicare Part A and also provided a supplementary program that covered the costs of physicians services and other items and services not covered under Part A is called Medicare Part B.
Those who are over age 65 but not eligible for Medicare can obtain a Medicare coverage by paying a monthly premium for Part A and Part B coverage.
Patient’s Responsibility
The patients responsibility or out of pocket expenses is the amount which a patient needs to pay after his claim is paid by the insurance or in upfront during the time of treatment and are usually determined by insurance companies according to the plan type.
Coinsurance
The portion of the balance of covered medical expenses, which a beneficiary must pay after payment of the deductible.
Deductible
A stipulated amount, which the covered person must pay toward the cost of medical treatment before the benefits of the program go into effect.
Copay
A standard amount, which insurance applies to the Patient for every Office, Outpatient or Inpatient visits as per the contract.
Professional Courtesy Letter
This is a letter issued by the Doctor to the Billing Office requesting them not to bill the patient for any balances.
Professional Courtesy Letter is only issued in rare instance for poor patients who cannot afford to pay their balances.
Some Professional Courtesy Letter clearly states that the serves performed to the patient are free of charge and neither him/her nor his insurance company to be billed. In this instance the entire balance is charge adjusted.
Consent Form or Waiver Form
An approval signed by the patient stating that he/she can be billed for all the co-pays and deductibles in a form or a format is called Consent Form or Waiver Form.
Some Doctor’s offices collect the co-pay amount from the patient initially while receiving the treatment itself. Check issued by the patient in this instance is forwarded to the billing office to make necessary cash entries in their system for the respective patient’s account.
These consent forms are also sent to the billing office along with the patient demographics. This consent form also confirms that the patient is responsible for all his/her balances if hi/her insurance coverage is not effective.
Patient Billing
The process of sending accurate bills to the patients for their responsibility is called Patient Billing.
A statement is sent to the patient giving complete details of his/her treatments and the amount received from his/her insurance company for the treatments and his/her responsibility, which the patient has to pay.
The pay to address (i.e.) the address where the patient has to send his/her check is clearly mentioned in the bill. Also the billing office phone number is mentioned on the bill so that patient’s can call up the billing office for clarifications regarding the bills received.
Follow up with the patient on the bill sent is done after 21 days of the dispatch date of the bill. A call is placed to the patient inquiring regarding the bill.
Budget Payments:
Some patients who cannot afford to pay the entire balance of their responsibility request for a budget payment pattern where they can pay their balances in installments. This type of payments is called Budget Payments.
Collections:
Patients refusing to pay bill or not paying bill after continuous follow-ups are moved to a separate account in the billing office. Also these patient’s accounts are forwarded to the legal representative of the billing office or any other entity to take legal actions in order to recover the balance from the patients this process is called Collections.
In cases where the patient is not able to pay their balances due to their financial difficulties then a Financial Disclosure Form is sent to the patient in order to receive complete details of his income and then the billing office will determine whether the balance of the patient can be adjusted or not.
Physicians & Hospitals
Type of Service
The kind of treatment or services provided to the patient is called the Type of Service.
Patients can undergo various kinds of treatments like Surgeries, Therapies etc.
Insurance Companies in order to identify the type of service provided to a patient, a type of service code is formed.
These Types of services codes are 2 digit numbers, which are assigned by the insurance companies in order to identify the type of service provided to their enrollees or patients.
This type of service code is a must field in the claim form (except Medicare) submitted to the carriers, incorrect usage of these type of service codes can result in claim denial.
Place of Service
The place where the treatment is rendered to the patient is called Place of Service. Patients go for treatments to various places like Doctor’s office, Hospitals etc.
Insurance Companies in order to identify the Place of service provided to a patient, a Place of service code is formed.
This Place of service code is a mandatory field in the claim form submitted to the carriers, incorrect usage of these Place of Service codes can result in claim denial.
Professional & Technical components
Professional Component
In a treatment rendered to a patient, the professional component of it means the portion of the total service provided by the physician. The professional component is used to report the physician’s services only.
E.g. Evaluation and Management or the supervision and interpretation of a test/procedure.
Technical Component
In a treatment rendered to a patient, the technical component of it means the portion of the total services provided by the facility. This includes the cost of technologist’s services, specific equipment and supplies and any facility overhead necessary for providing the service such as room charges.
Daily treatments provided to the patients in radiation therapy are purely technical components.
Total Procedure or Global Procedure
The combination of the physician and/or facility providing and/or reporting both technical and professional components.
E.g. Therapeutic Radiology Simulation – Aided Field Setting
Physician
Definition of a Physician: The Term physician includes a doctor of medicine (M.D), a doctor of osteopathy (D.O), a doctor of dental surgery or dental medicine (D.D.S or D.M.S), a chiropractor, a doctor of podiatry or surgical chiropody, and a doctor of optometry. All physicians must be legally authorized (licensed) to practice by the state in which they perform procedures or services.
Primary Care Physician:
Primary Care Physician in general term is a family doctor or the doctor one who is visited by the patient first for any kind of health problems.
Primary care physicians are also called Gate Keepers, as they are the ones who are contacted first by the patient.
Patients come to the doctors for various health problems; these primary care physician diagnoses the patient condition and take necessary treatments. If the patient condition needs special attention then he refers the patient to a Specialist.
Specialist:
Specialists are physician who practice on a particular specialty. Some of the Practitioners are Dentist, Oral Surgeon, Chiropractor, Podiatrist, and Optometrist etc.
A specialist can also be a PCP for the patient, in cases where the patient directly comes to the doctor for his health problems and the doctor diagnoses some problem, which is also is specialty then he becomes the PCP and Specialist for the patients.
PCP ‘s are termed as the referring doctors, while the specialist are termed as the rendering doctors.
A PCP can also be both the rendering and referring doctor as mentioned above.
Participation
Agreeing to Participate with an Insurance program means:
1. Physician agrees to accept assignment for all claims he submits; assignment means the physician requests direct payment from the Insurance Company.
2. The Physician agrees to accept Insurance allowable as payment in full for the services, regardless of the charge he makes.
3. The physician agrees to complete and file the claim forms for the patient at no charge to the patient.
4. The physician agrees not to bill the patient for services determined by the carrier to be not reasonable and necessary (unless he provided advance written notice and the patient agreed to pay). However the physician may bill for any non-covered services.
A physician or a group of physician can participate with as a single entity with Insurance Company. The process of getting participated with Insurance Company is called Enrollment.
A provider number is assigned to the group or individual physician based on the type of enrollment.
If the physician or a group does not agree upon the above points are termed as Non-Participating Providers.
Enrollment
The physician must sign the participation agreement form with the insurance company which will be processed by the Insurance Company and a provider number will be assigned for the group or Physician based on the type of enrollment.
The physicians or the group should give the following information for their enrollment with the Insurance Companies.
1. License copy of the doctor should be provided to the insurance.
2. Address of the treatment performed and the pay to address should be clearly mentioned.
3. The doctor should sign the enrollment form.
Billing Office
Billing Office
An office, which provides complete services of coding, maintaining patient’s records & accounts, Filing claims to Insurance companies, following up with the insurance companies, patients, assuring high productivity and reimbursement adhering to rules and laws is called a Billing Office.
To perform the above-mentioned actions the billing office has various departments. These department’s responsibilities are listed below. We will be discussing in detail regarding these departments in modules to follow.
Scan Department
This department is responsible for uploading, downloading, scanning all files and documents between the client office and the billing office.
Charges Department
Charges department is responsible for registering a patient in the system and also to enter all his treatment bills (Charges) in the system accurately.
Audit Department
Audit department’s responsibility is to ensure 100 percent error free data entry and analysis. It also helps to maintain & monitor high production standards.
Transmission Department
Transmission department is responsible for transmitting and confirming claims sent to the insurance companies and clearing houses electronically.
Claims Department
Claims department is responsible for printing paper claims (Primary and Secondary), auditing claim forms and dispatching claims to respective Insurance companies on weekly bases thro’ courier.
Account Receivables Department
Accounts receivables department is responsible for monthly collections, analysis and auditing of all accounts, following up on payments with the Insurance companies, patients, requesting and receiving information from the client office, facilities, doctors and insurance companies.
Cash Department
Cash department is responsible for posting all payments (Insurance payments and patient payments) accurately to the respective patient accounts and other accounts.
Patient Demographics
The Complete information regarding the patient (i.e.) the following items listed below consists of a Patient Demographics.
1. Patient’s First Name, Middle Name and Last Name
2. Patient’s Social Security Number
3. Patient’s address
4. Guarantor Details
5. ICD-9 code
6. Insurance Card Copy
7. Effective & expiry date of the coverage
8. Consent Form or Waiver Form
9. Referrals received from Primary Care Physician
Clear details of the patient and all the other necessary information required to register the patient in the system should be available in the patient demographics.
Based on this information a new account is opened in the software used by the billing office for a particular patient. All the details available in the patient demographics are entered accurately into this patient’s account.
ICD-9-CM Codes – International Classification of Diseases (Diagnosis Code).
ICD-9-CM is an acronym for International Classification of Diseases 9th Revision Clinical Modification.
ICD-9-CM is a statistical classification system, which arranges diseases and injuries into groups according to established criteria.
Most ICD-9-CM codes are numeric and consist of three, four or five numbers and a description. The World Health Organization revises these codes completely about every 10 years. HCFA publishes additions, changes and deletions to the ICD-9-CM Codes every year.
A new revision of ICD-CM codes is ICD-10-CM, but ICD-9-CM is valid until Sept 30,2000.
CPT-4 - Current Procedural Terminology
Current Procedural Terminology (CPT) is a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical and diagnostic services – serving as an effective means for reliable nationwide communication among physicians, patients and third parties.
HCPCS Coding System
HCPCS is the acronym for the HCFA (Health Care Financing Administration) Common Procedure Coding System. The HCPCS coding system is structured in three levels; each of the three HCPCS levels is its own unique coding system.
Charge Sheets or encounter form:
This is a data sheet sent from the doctor’s office or facility to the billing office, which provides the following information.
1. Facility Name
2. Patient Name
3. Diagnosis
4. Date of Treatment
5. Name of Attending Doctor
6. Name of Referring Doctor
7. ICD-9 Code
8. Place of Service
9. Procedure Code & Description of Procedure
10. Signature of the Physician
11. Date of Signature
All these data’s are updated in the billing software to generate a claim to the Insurance companies.
Modifiers
A modifier provides a means by which a practitioner can indicate that a service or procedure was altered or performed with regards to number of times in specific circumstances, but not changed in its definition or code.
CPT Modifiers
CPT modifiers are two-digit numeric. CPT modifiers are typically used to indicate.
- A service or procedure has both a professional and technical component.
- A service or procedure was performed by more than one physician and/or in more than one location.
- More or less have the service or procedure as described was performed.
- Only part of service was performed.
- An adjunctive service performed.
- A bilateral procedure was performed.
- A service or procedure was provided more than once.
- Unusual events occurred.
Referrals & Pre authorizations
Referral:
A referral is an authorization provided by the Primary Care Physician referring a patient to a specialist. Submitting a referral along with a claim is necessary to get reimbursement.
Pre-Authorizations:
The process of obtaining permission to perform a service from the insurance carrier before the service is performed is called Pre-authorization. Prior authorization only required for certain type of procedures or specialty.
The Prior authorization number should be mentioned on the claim.
Additional Documents:
Lab reports, office notes and other medical records are considered as additional documents. For certain procedures and services we need to attach these additional documents in order to justify the need of that procedure being performed to the patient relating to his condition.
Accounts Receivables Department
Accounts receivables department is responsible for monthly collections, analysis and auditing of all accounts, following up on payments with the Insurance companies, patients, requesting and receiving information from the client office, facilities, doctors and insurance companies.
Patient Account
All information and transactions regarding a patient is available in an account called patient account.
Following are the information available in the patient account.
1. Patient’s Name and address.
2. Patient’s Home and Work Phone number
3. Doctor Number
4. Patient type
5. Credit Status
6. Bill Cycle
7. Patient’s Date of Birth and Age
8. Account number
9. Patient’s Social Security Number
10. Last Charge entered date
11. Last Insurance paid date and amount
12. Diagnosis code
13. Active Coverage details
14. Achieved coverage details
15. Subscriber Details
16. Balance amount pending (available in age wise)
17. Insurance balance and patient balance
18. All Budget transactions
19. Insurance coverage ID number and Group number
20. Patient notes, billing notes and collection notes
21. Off-Bill Comments and On-Bill comments
22. Referring doctor and Rendering doctor name on each Charge
23. Date of Service, procedure code, description, diagnosis code, Number of units, Charge value, Date of filing, Date of refiling, Amount paid by insurance (Primary secondary and tertiary), write-off amount and balance amount pending are available for each charge.
24. Transaction details
25. Co-pay and deductible amount
Now lets discuss on some of the information available in the patient account in detail, which were not discussed in the previous modules.
Doctor Number
All doctor’s information are maintained in a particular table or master file in the billing software. Each doctor (referring or rendering) is assigned with a particular number in order to retrieve any information relating to that particular doctor easily. Assigning of doctor number is a basic advantage in formulating reports.
Patient Type
Patient Types are assigned by the billing office on a group of patient accounts based on the patient’s coverage. Patient types help the billing office staff to understand to rules, to study the payment pattern and to solve the issues of a particular insurance company or a group of insurance companies, which fall under the same category.
Credit Status
This is a status indicator of the number of bills sent to a patient for his responsibility. Each time when a patient bill is generated the credit status gets updated in order to determine the follow up strategy with the patient and also to determine whether the patient can be moved to collections.
Balance Amount Pending
The amount that needs to be collected from the Insurance Company and the patient is called Balance amount pending.
Age: This shows the number of days the claims are outstanding from the date of charge entered for a patient.
Date of Filing & Refiling
Date on which a charge is filed to Insurance Company is called Filing. The date on which the same claim is sent again to Insurance Company is called Refiling.
Analysis
The complete study and auditing of the following is referred as analysis.
1. Types of Insurance Plans
2. Mode of Payments
3. Payer Mix
4. Update on newsletters
5. Patient balance accuracy
6. Cash posting accuracy
7. Charge Entry accuracy
8. Complete details on major insurance companies
9. Update on contracts
10. Global issues
11. Patient accounts
12. Update on fee schedules
13. Rules and Regulations for claim filing
14. Research on Claim forms
15. Study on Coding
16. Update on Medical necessity denials
17. Study on covered and non covered services
18. Study on proper usage of Modifiers
19. Study on Time limit for filing claims
20. Study on appeals procedures
21. Understanding the concept of claims processing by each carrier.
Insurance Follow-ups
After complete analysis of accounts and various aspects as mentioned above, some of the accounts on which we need information are followed up with the insurance companies. The process of requesting and/or clarifying information with the insurance companies is called Insurance Follow ups.
Claim status is obtained on problematic claims in order to take appropriate actions based on the information provided by the insurance company.
Follow up with Insurance companies are done for various reasons some of them are listed below.
1. To know Claim status
2. To request clarification on denials
3. To obtain Provider enrollment policy details
4. To reprocess a claim denied incorrectly
5. To verify patient’s Insurance coverage
6. To confirm claims transmitted electronically
Denied Claims
Claims sent to the insurance company processed but not paid due to a reason are called denied claims.
Following are some of the denial reasons.
1. Truncated diagnosis
2. Patient’s coverage Expired
3. Patient has pre-existing condition
4. Incorrect place of service
5. Inclusive procedure
6. No prior authorization
7. Referral required
Patient Follow-ups
After complete analysis on patient balances, accuracy of patient’s responsibility is checked and a bill is sent to the patient. If the patient does not respond to the bill sent then patient follow-up takes place. A call is placed to the patient and we request them to pay their bill immediately. This process is called Patient Follow-ups.
Common Terminologies used in US Healthcare Industry:
Payor: Insurance
Provider: Hospital or Physician
SSN: Social Security Number
PCP: Primary Care Physician
PCL: Professional Courtesy Letter
HMO: Health Maintenance Organization
PPO: Preferred Provider Organization
POS: Point of Service
EPO: Exclusive Provider Organization
EOB: Explanation of Benefits
ABN: Advance Beneficiary Notice
CMS: Center for Medicare and Medicaid Services
COBRA: Consolidated Omnibus Budget Reconciliation Act
OIG: Office of Inspector General
DME: Durable Medical Equipment
ESRD: End Stage Renal Disease
EOMB: Explanation of Medicare Benefits
LGHP: Large Group Health Plan
EGHP: Employer Group Health Plan
GEP: General Enrollment Period
HCFA: Health Care Financing Administration
HIPAA: Health Insurance Portability and Accountability Act
IEP: Initial Enrollment Period
LTR: Life Time Reserve Days
MSN: Medicare Summary Notice
MSP: Medicare Secondary Payer
NP: Nurse Practitioner
IP: Inpatient
OP: Outpatient
PA: Physician Assistant
PSO: Provider Sponsored Organization
QMB: Qualified Medicare Beneficiary
SNF: Skilled Nursing Facility
HHA: Home Health Agency
SHMO: Social Health Maintenance Organization
WC: Workers Compensation
VA: Veterans Administration
CHAMPUS: Civilian Health and Medical Program of the Uniformed Services
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