Under the Health Insurance Portability and Accountability Act (HIPAA), an individual designated to help the provider remain in compliance by setting policies and procedures (P & P) and by training and managing the staff regarding HIPAA and patient rights. The PO is usually the contact person for questions and complaints. Also known as privacy official (PO).

Agreement between the patient and a doctor, podiatrist, dentist, or optometrist who has decided not to offer services through the Medicare program. This doctor cannot bill Medicare for any service or supplies given to the patient and all his or her other Medicare patients for at least 2 years. There are no limits on what the patient can be charged for the services under a private contract. The patient must pay the full amount of the bill and submit his or her own insurance claims for reimbursement. The GJ modifier must be used on all insurance claims for services rendered by an “opt out” provider for emergency/urgent services.

Nursing services by a registered nurse (RN) or licensed practical nurse (LPN) who is not employed by an institution (hospital, home health care agency, skilled nursing facility, or hospice provider) but may work in an institution caring for a patient on a fee-for-service basis. Private duty care also may occur in the home.

Medicare Advantage Plan in which the patient may go to any Medicare-approved physician or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare program, decides how much it will pay and what the patient should pay for the medical services.

Medical facility that is privately owned and operated by an individual, several people, or a corporation.

Conventional health care coverage bought from an insurance company that allows the insured to select his or her physicians, hospitals, and other health care facilities.
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Voluntary insurance programs available from private firms or from the government by which an individual may obtain protection against the possibility of loss due to a contingency.

Work of a professional health care provider who is independent of financial or external policy control by professional peers, except for licensing and other legal restrictions.

Verbal discussions that are confidential and not to be disclosed except by specific consent of the patient.