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.