Three-tier coding system developed by the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), used for reporting physician/supplier services and procedures. Providers must use HCPCS to receive payment by Medicare and Medicaid programs. Level I consists of national codes to code ambulatory, laboratory, radiology, and other diagnostic services for Medicare billing. This level contains only the American Medical Association’s CPT codes. Level II consists of HCPCS national codes used to report ambulance services, durable medical equipment, and orthotic and prosthetic devices. Level III HCPCS regional/local codes have been discontinued. Pronounced “hick-picks” and formerly referred to as Health Care Financing Administration Common Procedure Coding System (HCPCS) . Also known as national codes .

In HCPCS Level II coding, two alpha digits, two alphanumerical characters, or a single alpha digit placed after the usual five-digit CPT procedure code number. These modifiers are used to identify situations that change the description of service or supply. They are accepted by insurance carriers nationally and are updated annually by the Centers for Medicare and Medicaid Services (CMS) (see Box H-2 and Figure H-1 ).Box H-2HCPCS MODIFIERSWhen taking x-ray films of both feet, the billing portion of the insurance claim appears as follows:05/06/XX73620 RT Radiologic examination, foot—right05/06/XX73620 LT Radiologic examination, foot—left HCPCS Level II alpha modifiers (LT and RT used to identify left and right hands) and alphanumerical modifiers (FA through F9) used to identify digits (fingers) of left and right hands.

Professional alliance of individuals who are organized to improve financial management of health care institutions and related health care organizations and do the following: (1) Foster and increase knowledge of and proficiency in financial management; (2) Conduct and participate in educational programs and activities concerning financial management; (3) Provide media for the interchange of ideas and dissemination of material relative to financial management; (4) Strengthen cooperation among individuals of varying disciplines in financial management; (5) Develop curricula and financial management supporting material for use by educational institutions; (6) Cooperate with health care institutions and related health care organizations and agencies, as well as other interested groups in matters pertaining to financial management; (7) Establish and promulgate principles relative to financial management; (8) Promote and encourage financial management standards of performance for individuals and institutions in the various areas of financial management; and (9) Undertake research in financial management related to these objectives.

Created by the American National Standards Institute’s Executive Standards Council in December 1995 to replace the Health Informatics Standards Planning Panel (HISPP). Their basic objective is to achieve a high level of support of the health care users, providers, and business partners for development and use of health care information standards in a cooperative environment. HISB developed an inventory of candidate standards for consideration as possible Health Insurance Portability and Accountability Act (HIPAA) standards. In this forum, American health care providers, information systems vendors, organized users, and interested parties work together with Standards Development Organizations (e.g., Health Level 7, American Society for Testing and Materials, and Institute of Electrical and Electronics Engineers, Inc.) to resolve the many issues around harmonizing and coordinating standards evolution.

Association focused on providing leadership for the optimal use of health care information technology and management systems for the betterment of human health. Founded in 1961 with offices in Chicago, Washington, D.C., and other locations across the country.

National health care fraud and abuse data bank created by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Its information includes actions reported against health care providers, suppliers, and practitioners for fraud and abuse. The HIPDB is used with the national practitioner data bank (NPDB).