Glossary

Under HIPAA, this is a group of related data elements in a transaction.

Dialysis performed with little or no professional assistance (except in emergency situations) by an ESRD patient who has completed an appropriate course of training, in a dialysis facility or at home.

Operation of a trade or business by an individual or by a partnership in which an individual is a member.

Medicare's share of SECA is used to fund the HI Trust Fund. In fiscal year 1996, self-employed individuals contributed 2.9 percent of taxable annual income, with no limitation. net income of most self-employed persons to provide for the OASDI and HI programs.

An individual or organization that assumes the financial risk of paying for health care.

The reduction of funds to be used for benefits or administrative costs from a federal account based on the requirements specified in the Gramm-Rudman-Hollings Act.

Medical care and items such as medical diagnosis and treatment, drugs and biologicals, supplies, appliances, and equipment, medical social services, and use of hospital RPCH or SNF facilities. (42 CFR 400.202).

The area where a health plan accepts members. For plans that require you to use their doctors and hospitals, it is also the area where services are provided. The plan may disenroll you if you move out of the plan’s service area.

The area where a Medicare Private Fee-for-Service plan accepts members.

A general description of the types of services provided under the service and/or thecharacteristics that define the service category.