Healthcare Policy Terms: Demystified!

Ever notice how government employees and elected officials seem to speak a different language when it comes to healthcare? It can make you feel as if you’ve entered the alternate universe of LOA…the Land of Acronyms. Whether you’re talking about national competitive bidding (NCB) or other home medical equipment policies, this guide can make those conversations more effective and understandable.

beneficiary
The patient, i.e., the person receiving the medical equipment or services.

CBA
Competitive bid area; the geographical region involved in Medicare competitive bidding.

clinician
In the HME industry, most commonly refers to a physician, nurse, occupational therapist or physical therapist, nurse practitioner or physician’s assistant.

CMS
Centers for Medicare & Medicaid Services.

complex rehab technology
Medically necessary equipment requiring a high degree of customization, including sizing, configuration and programming to meet the needs of one specific patient. Patients typically have conditions that are present at birth, progressive or degenerative, caused by trauma or injury, and/or are neuromuscular in nature.

DME
Durable medical equipment, another term for (and the Medicare-preferred term for) HME.

HIPAA
The Health Insurance Portability & Accountability Act requires most healthcare providers to protect patients’ health information and keep it private, while also ensuring that health information can be disclosed effectively when needed.

HHS
The U.S. Department of Health & Human Services, of which Medicare and Medicaid are a part.

HME
Home medical equipment, used in the industry to refer to medical equipment used by patients in their homes, not in hospitals or facilities.

medical necessity
Describes medical equipment or services that are necessary and reasonable to improve a patient’s function. and that meet current medical standards.

payer or payor
A healthcare insurance organization, such as Medicare or BlueCross BlueShield.

supplier
A business that sells home medical equipment. Also called dealer or provider.

This article originally appeared in the Consumer Edition 2012 issue of Mobility Management.

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