Frequently Used Terms

The University’s Billing Compliance Plan, in place since 1996 and periodically amended, addresses billing for clinical activity by full-time and part-time CUIMC clinicians for which professional fee revenues either flow through University accounts or are subject to an academic assessment by the University.

Agency within the United States Department of Health and Human Services that administers the Medicare, Medicaid, and State Children’s Health Insurance programs.

The provision of similar services “for example, more than one subsequent hospital visit “to the same patient by more than one physician on the same date. 

Current Procedural Terminology, 4th Edition (“CPT-4”) is the coding system used by Medicare, Medicaid, and private payers to describe medical, surgical, and diagnostic services.

The United States government's principal agency for protecting the health of all Americans and providing essential human services; DHHS agencies include the Office of Inspector General and the Centers for Medicare and Medicaid Services.

The International Classification of Diseases, Tenth Edition (ICD-10) is a clinical cataloging system that went into effect for the U.S. healthcare industry on Oct. 1, 2015. Accounting for modern advances in clinical treatment and medical devices, ICD-10 codes offer many more classification options compared to those found in its predecessor, ICD-9.

Incident-to is defined as services or supplies that are furnished incident to a physician's professional services when the services or supplies are furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness and services are performed in the physician's office or in the patient's home.

The Columbia University Irving Medical Center Office for Billing Compliance implements the University's Billing Compliance Plan and maintains the Billing Compliance Program.

The Office of the Inspector General of the U.S. Department of Health and Human Services is responsible for protecting the integrity of Federal health care programs, including Medicare and Medicaid.

The Office of the Medicaid Inspector is a sub-agency within the New York Department of Health and is responsible for protecting the integrity of State health care programs, including Medicaid. The Medicaid Fraud Control Unit (“MFCU”) within the Office of the New York State Attorney General has concurrent jurisdiction to investigate and prosecute instances of Medicaid fraud.

An evaluation and management (“E/M”) service shared or split between a physician and a Non-Physician Provider; shared visits are subject to specific Medicare billing rules.