Insurance of an individual before the effective date of another policy and the subscriber has a different identification number.

Insurance coverage of an individual who was covered under a previous employer and is now to be covered with the same insurance company under a new employer.

The “from” and “through” dates of a patient’s stay in a hospital, skilled nursing facility (SNF), or nursing home that ended within 60 days of the current hospital or SNF admission.

1. Confidentiality. 2. Free from observation such as closed doors, drawn curtains around a hospital bed. 3. Under the Health Insurance Portability and Accountability Act (HIPAA), use and disclosure of protected health information is permissible for treatment, payment, or health care operations (TPO).

Federal legislation that became effective on September 27, 1975, and established an individual’s right to review his or her medical records maintained by a federal medical care facility such as a VA medical center or U.S. Public Health Service facility and to contest inaccuracies in such records. This act also began to limit government use of the Social Security number. Some federal agencies or federally funded institutions may be regulated by both the Privacy Act and the HIPAA standards. Such entities are required to comply with both sets of regulations. Although the HIPAA standards generally provide more restrictive regulations, entities are advised to revise their policies and procedures to comply with both the HIPAA standards and the Privacy Act.

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.