Glossary

IRS Reporting (1095 Reporting)
Exchange of data with the IRS thru the DSH. This reporting is send monthly & annually forFFM & only monthly forSHOP

A subset of the HCPCS Level II code set with a high-order value of "J" that has been used to identify certain drugs and other items.

An organization that accredits healthcare organizations. In the future, the JCAHO may play a role in certifying these organizations' compliance with the HIPAA A/S requirements.

A group health plan that covers employees of either an employer or employee organization that has 100 or more employees.

A formal request from the requestor on organizational letterhead detailing their data needs and purposes. Additionally, if this project is federally funded a letter of Support is required from the federal Project Officer on their organizational letterhead.

A letter from the Federal Project Officer justifying the need for CMS data and supporting the requestor's use of such data.

Determination based on §1879 or §1870 or §1842(L) of the Act, of whether the beneficiary and the provider did not and could not have been reasonably expected to know that payment would not be made for services.

Liability insurance is insurance that protects against claims for negligence or inappropriate action or inaction, which results in injury to someone or damage to property.

This means a long-term care facility has met certain standards set by a State or local government agency.

An entity that is licensed or otherwise authorized by the State to assume risk for offering health insurance or health benefits coverage. The entity is authorized to accept prepaid capitation for providing, arranging, or paying for comprehensive health services under an M+C contract. Designation that an M+C organization has been reviewed and determined "fully accredited" by a CMS-approved accrediting organization for those standards within the deeming categories that the accrediting organization has the authority to deem.