Procedural code in the CPT book that is preceded with a plus (+) symbol indicating the code may be reported in addition to the parent or primary procedure code number (see Box A-1 ). Add-on codes are never reported for stand-alone services but are reported secondarily in addition to the primary procedure.Box A-1ADD-ON CODEParent code 11000Biopsy of skin … single lesion each separate/additional lesion (list separately in addition to code for primary procedure)Add-on code +11101

Individual who becomes insured after the effective date of a group insurance policy.

Health care services not covered by Medicare and reductions in premiums or cost sharing for Medicare-covered services. Additional benefits are specified by the Medicare Advantage (MA) Organization and are offered to Medicare beneficiaries at no additional premium. Those benefits must be at least equal in value to the adjusted excess amount calculated in the adjusted or average community rate (ACR). An excess amount is created when the average payment rate exceeds the adjusted community rate (as reduced by the actuarial value of coinsurance, copayments, and deductibles under Parts A and B of Medicare). The excess amount is then adjusted for any contributions to a stabilization fund. The remainder is the adjusted excess, which is used to pay for services not covered by Medicare and/or is used to reduce charges otherwise allowed for Medicare-covered services. Additional benefits can be subject to cost sharing by plan enrollees. Additional benefits can also be different for each MA plan offered to Medicare beneficiaries.

Form issued by a Medicare administrative contractor (MAC) to a provider asking for more information in a patient’s medical record so that coverage, coding, and payment determination can be made concerning a claim.

Option in a life insurance policy in which current dividends are used as a net single premium to purchase 1-year term insurance to maintain level protection for a period up to the insured’s retirement age. This is often used with a split-dollar plan. Also called additional insurance option or fifth dividend option.

Commonly used acronym in relation to a hospital charge description master (CDM); also called charge master.

Under HIPAA rules, implementation specification under the security rule related to encrypted electronic mail that contains the patient’s protected health information. The provider must implement the specification as stated in the rule, implement protections equivalent to the rule, or clearly document why the implementation specification does not apply.