In the Medicare program, a beneficiary who receives blood may either restore the blood or pay the provider’s charges for the unrestored blood. Blood is replaced on a pint-for-pint or unit-for-unit basis.

In a workers’ compensation case, injured worker who is not represented by an attorney.

Obligation (amount owed) that is not secured or backed by any form of collateral.

Procedure or service that is unique or an atypical finding that affects the patient’s treatment. When billing for an unusual procedural service, a -22 modifier is appended to the usual five-digit CPT procedure code when the service provided is greater than that usually required for the listed procedure.

Deliberate manipulation of Current Procedural Terminology (CPT) codes for increased payment by using a code for a higher payment than the code for the service performed (e.g., a podiatrist who performs a simple nail clip service but bills for foot surgery). Under the False Claims Act, providers who are caught upcoding face a civil monetary penalty of $5,000 to $10,000 per service. In addition, the federal government can make an assessment against a provider of up to three times the service claim amount as repayment for a Medicare case. Also called code creep or overcoding .

Annual adjustment of the Medicare fee schedule to raise or lower base payment amounts to allow for changes in cost of living by determining the relative values of new and revised procedure codes. See Medicare economic index (MEI) and Medicare Volume Performance Standard (MVPS) .