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Commonly used provider enrollment terms and their definitions
Last Modified: 3/25/2024
Location: FL, PR, USVI
Business: Part A, Part B
Below is a list of terms commonly used in the Medicare enrollment process:
• Accredited provider/supplier -- Means a supplier that has been accredited by the Centers for Medicare & Medicaid Services (CMS)-designed accreditation organization.
• Add -- For purposes of completing the Form CMS-855 or Form CMS-20134 enrollment applications, you are adding enrollment information to your existing enrollment record (e.g., practice locations). When adding a practice location an application fee may be required for applicable institutions.
• Administrative location -- Means a physical location associated with a Medicare Diabetes Prevention Program (MDPP) supplier’s operations from where: (1) coaches are dispatched or based; and (2) where MDPP services may or may not be furnished.
• Advanced diagnostic imaging service -- Means any of the following diagnostic services:
1. Magnetic Resonance Imaging (MRI)
2. Computed Tomography (CT)
3. Nuclear Medicine
4. Positron Emission Tomography (PET)
• Advanced Life Support, level 1 (ALS1) -- Transportation by ground ambulance vehicle, medically necessary supplies and services, and either an ALS assessment by an ALS personnel or the provision of at least one ALS intervention, refer to 42 CFR (Code of Federal Regulations) section 414.605.
• Advanced Life Support, level 2 (ALS2) -- Either transportation by ground ambulance vehicle, medically necessary supplies and services, and the administration of at least three medications by intravenous push/bolus or by continues infusion, excluding crystalloid, hypotonic, isotonic and hypertonic solutions (Dextrose, Normal Saline, Ringer’s Lactate) or transportation, medically necessary supplies and services and at least one of the seven ALS procedures specified in 42 CFR 414.605.
• Air ambulance -- Fixed wing and rotary wing. Air ambulance is furnished when the patient’s medical condition is such that transport by ground ambulance is not appropriate: one patient’s condition requires rapid transport to a treatment facility and second patient is inaccessible by ground or water vehicle.
• Applicant -- The individual (practitioner/supplier) or organization who is seeking enrollment into the Medicare program.
• Applicant versus provider/supplier -- The provider is the entity furnishing the service, (e.g., the hospital, home health agency, etc.). The applicant is the business entity that the provider is set up as. For instance, suppose the provider is a hospital organized as a corporation. (That is, the hospital and the corporation are one in the same, operating under the same TIN). In this case, the hospital is the provider, and the corporation is the applicant.
• Approve/Approval -- Means the enrolling provider or supplier has been determined to be eligible under Medicare rules and regulations to receive a Medicare billing number and be granted Medicare billing privileges or to enroll to solely order, certify, or refer the items or services described in 42 CFR 424.507.
• Authorized Official -- Is an appointed official (e.g., chief executive officer, chief financial officer, general partner, chairman of the board, or direct owner) to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes or updates to the organization’s status in the Medicare program, and to commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program. For purposes of this definition only, the term “organization” means the enrolling entity as identified by its legal business name and tax identification number.
• Bankruptcy -- When a provider/supplier files for protection in a Federal bankruptcy court, it may choose, with the permission of the court, to cease operations (chapter 7) or reorganize (Chapter 11). When a provider/supplier files under Chapter 7, it will liquidate its assets and cease operations and must notify the contractor of this fact. When the assets are sold to a different entity that entity must enroll with the contractor if it wishes to bill the Medicare program.
• Basic Life Support (BLS) -- Ambulances must be staffed by at least two people – who meet the requirements of state and local laws where the services are being furnished and where at least one of whom must (1) be certified at a minimum as an emergency medical technician – basic (EMT-basic) by the state or local authority where the services are being furnished and (2) be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
• Billing agency -- A company that the applicant contracts with to prepare, edit and/or submit claims on its behalf. A billing agency is not enrolled in the Medicare program. A billing agency submits claims to Medicare in the name and billing number of the provider or supplier that furnished the service(s).
• Certified Part A Provider/Supplier -- Part A provider/supplier who is State approved based on Regional Office’s survey or certification unit. Providers/suppliers are approved or “certified” by Medicare if they’ve passed an inspection conducted by a state government agency.
• Certified Part B Provider/Supplier -- Part B certified providers/suppliers include audiologist, ambulance service suppliers, Independent Clinical Labs (CLIAs), occupational therapist, physical therapist, speech language pathologist and mass immunization roster billers. Effective dates are based on Julian date of application (receipt date).
• Change -- For purposes of completing the CMS-855 or CMS-20134 enrollment applications, you are replacing existing information with new information (e.g. practice location, ownership) or updating existing information (e.g. change in suite #, telephone #). If you are changing a practice location an application fee is not required.
• Change in majority ownership -- Occurs when an individual or organization acquires more than a 50 percent direct ownership interest in a home health agency (HHA) or hospice during the 36 months following the HHA’s or hospice’s initial enrollment into the Medicare program or the 36 months following the HHA’s or hospice’s most recent change in majority ownership (including asset sales, stock transfers, mergers, or consolidations). This includes an individual or organization that acquires majority ownership in an HHA or hospice through the cumulative effect of asset sales, stock transfers, consolidations, or mergers during the 36-month period after Medicare billing privileges are conveyed or the 36-month period following the HHA’s or hospice’s most recent change in majority ownership. (See 42 CFR § 424.550(b) for more information on HHA and hospice changes of ownership.)
• Change of ownership (CHOW) -- Is defined in 42 CFR 489.18 (a) and generally means, in the case of a partnership, the removal, addition, or substitution of a partner, unless the partners expressly agree otherwise, as permitted by applicable State law. In the case of a corporation, the term generally means the merger of the provider corporation into another corporation, or the consolidation of two or more corporations, resulting in the creation of a new corporation. The transfer of corporate stock or the merger of another corporation into the provider corporation does not constitute change of ownership.
• CMS 855A -- Health Care Providers that will bill Medicare Administrative Contractors for Part A services -application to be completed by a provider (e.g., hospital).
• CMS 855B -- Health Care Suppliers -application to be completed by a supplier (e.g., Ambulance Company) that will bill Medicare Administrative Contractors for Part B medical services furnished to Medicare beneficiaries.
• CMS 855I -- Individual Health Care Practitioners - A physician or non-physician practitioner who renders medical services to Medicare beneficiaries must complete this application. This form is processed through the Medicare carrier.
• CMS 855C -- Indirect Payment Procedure (IPP) entities. These types of applications must be approved by the PEOG BFL.
• CMS 855O -- Individual who is enrolling for the sole purpose of ordering and referring services to Medicare beneficiaries.
• CMS 855S -- DMEPOS Supplier Application - A supplier that wishes to enroll in the Medicare program and provide Medicare beneficiaries with durable medical equipment, prosthetics, orthotics, or supplies. The National Supplier Clearinghouse (NSC) is responsible for processing the application.
• CMS 20134 -- Medicare Diabetes Prevention Program (MDPP) Suppliers – An organization wishes to furnish MDPP services.
• CMS- approved accreditation organization -- Means an accreditation organization designated by CMS to perform the accreditation functions specified.
• Coach -- An individual who furnished Medicare Diabetes Prevention Program (MDPP) services on behalf of an MDPP supplier as an employee, contractor or volunteer.
• Community Setting -- A location where the MDPP supplier furnishes MDPP serviced outside of their administrative locations in meeting location open to the public. A community setting is a location not primarily associated with the supplier where many activities occur, including but not limited to MDPP services. Community settings may include, for example, church basements or multipurpose rooms in recreation centers.
• Contractor -- Administers the Medicare program for the government agency.
• Coupon 8109 -- (Internal Revenue Service) IRS document that is pre-printed with the tax identification number and legal business name.
• CP-575 -- IRS documents confirming the tax identification number and legal business name
• Deactivate -- The provider or supplier’s billing privileges were stopped but can be restored upon the submission of updated information.
• Delegated official -- An individual, delegated by the “Authorized Official,” with the authority to report changes and updates to the enrollment record. The delegated official must be an individual with an ownership or control interest in (as that term is defined in section 1124(a)(3) of the Social Security Act), or be a W-2 managing employee of, the provider or supplier.
• Delete/Remove -- For purposes of completing the Form CMS-855 or CMS-20134 enrollment applications, you are removing existing enrollment information. If you are deleting or removing a practice location an application fee is not required.
• Deny/Denial -- The enrolling provider or supplier has been determined to be ineligible to receive Medicare billing privileges for Medicare covered items or services provided to Medicare beneficiaries or to enroll solely to order, certify, or refer the items or services described in 42 CFR 424.507.
• Director – Means a director of a corporation, regardless of whether the provider or supplier is a non-profit entity. This includes any member of the corporation’s governing body irrespective of the precise title of either the board or the member; said body could be a board of directors, board of trustees, or similar body.
• Direct or indirect ownership -- The following example illustrates the difference between direct and indirect ownership: The supplier listed in Section 2 of the CMS 855B is an ambulance company that is wholly (100 percent) owned by Company A. Here, Company A is considered to be a direct owner of the supplier (the ambulance company), in that it actually owns the assets of the business. Now assume that Company B owns 100 percent of Company A. Company B is considered an indirect owner - but an owner, nevertheless - of the supplier. In other words, a direct owner has an actual ownership interest in the supplier, whereas an indirect owner has an ownership interest in an organization that owns the supplier.
• Divestiture -- The act of a provider/supplier selling off part or all of its assets, whether voluntarily or by court order. Whether or not a divestiture constitutes a change of ownership (CHOW) for a provider depends on the structure of the transaction.
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) -- Means (1) durable medical equipment (as defined in section 1861(n) of the Social Security Act); (2) prosthetic devices (as described in section1861(s)(8) of the Social Security Act); (3) orthotics and prosthetics (as described in section1861(s)(9) of the Social Security Act); (4) surgical dressings (as described in section 1861(s)(5) of the Social Security Act); (5) such other items as the Secretary may determine; (6) home dialysis supplies and equipment( as described in section 1861(s)(2)(F) of the Social Security Act); (7) immunosuppressive drugs (as described in section 1861(s)(2)(J) of the Social Security Act); (8) therapeutic shoes for diabetics (as described in section 1861(s)(12) of the Social Security Act); (9) oral drugs prescribed for use as an anticancer therapeutic agent (as described in section 1861(s)(2)(Q) of the Social Security Act); and (10) self-administered erythropoietin (as described in section 1861(s)(2)(P) of the Social Security Act).
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Medicare Administrative Contractor (MAC) -- The DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or "jurisdiction", servicing suppliers of DMEPOS.
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier -- Means a business or individual that furnishes durable medical equipment, prosthetics, orthotics, and supplies.
• Effective Date -- Means the date on which a provider’s or supplier’s eligibility was initially established for the purposes of submitting claims for Medicare-covered items and services, and/or ordering or certifying Medicare-covered items and services.
• Eligible coach -- An individual who CMS has screened and determined can provide MDPP services on behalf of an MDPP supplier.
• Enroll/Enrollment -- The process that Medicare uses to establish eligibility to submit claims for Medicare covered services and supplies. The process includes:
• Identification of a provider or supplier;
• Validation of the provider or supplier’s eligibility to provide items or services to Medicare beneficiaries;
• Identification and confirmation of the provider or supplier’s practice locations and owners; and,
• Granting the provider or supplier Medicare billing privileges
• Enrollment application -- A CMS-approved enrollment application or an electronic Medicare enrollment process approved by the Office of Management and Budget (OMB).
• FID -- Fraud Investigative Database
• Final adverse action -- One or more of the following actions:(i) A Medicare-imposed revocation of any Medicare billing privileges; (ii) Suspension or revocation of a license to provide health care by any State licensing authority; (iii) Revocation or suspension by an accreditation organization; (iv) A conviction of a Federal or State felony offense (as defined in section 424.535(a)(3)(i)) within the last 10 years preceding enrollment, revalidation, or re-enrollment; or (v) An exclusion or debarment from participation in a Federal or State health care program.
• Financial control -- (a) An organization or individual is the owner of a whole or part interest in any mortgage, deed of trust, note, or other obligation secured (in whole or in part) by the provider or any of the property or assets of the provider, and (b) The interest is equal to or exceeds five percent of the total property and assets of the provider.
• HCCL -- Health Care Clinic License (same as HCCR)
• HCCR license (health care services clinic) -- A business operating in a single structure or facility, or in a group of adjacent structures or facilities operating under the same business name or management, at which tender changes for reimbursement for such services. Section 456.0375, Florida Statutes, requires every such clinic to register separately even though operated under the same business name or management.
• Immediate family member or member of a physician's immediate family -- Means (under 42 CFR § 411.351) a husband or wife; birth or adoptive parent, child, or sibling; stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild; and spouse of a grandparent or grandchild.
• Inactivate -- The provider/supplier will be unable to use its billing number for claims processing. Upon taking this action, notify the applicant you have done so and the reason.
• Indirect ownership -- Indirect ownership interest means any ownership interest in an entity that has an ownership interest in the enrolling or enrolled provider or supplier or any ownership interest in an indirect owner of the enrolling or enrolled provider or supplier. The amount of indirect ownership interest is determined by multiplying the percentages of ownership in each entity.
• For example, if A owns 10 percent of the stock in a corporation that owns 80 percent of the provider or supplier, A's interest equates to an 8 percent indirect ownership interest in the provider or supplier and must be reported on the enrollment application. Conversely, if B owns 80 percent of the stock of a corporation that owns 5 percent of the stock of the provider or supplier, B's interest equates to a 4 percent indirect ownership interest in the provider or supplier and need not be reported.
• Ineligible coach -- Means an individual whom CMS has screened and determined cannot provide MDPP services on behalf of an MDPP supplier.
• Institutional provider -- Means (for purposes of the Medicare application fee only) any provider or supplier that submits a paper Medicare enrollment application using the Form CMS–855A, Form CMS–855B (not including physician and non-physician practitioner organizations), Form CMS–855S, or associated Internet-based Provider Enrollment, Chain and Ownership System (PECOS) enrollment application.
• IRS form 501c(3) -- This pre-printed letter can be used as IRS documentation showing the Tax ID and Legal Business Name of the entity that is a Non-Profit, or is tax exempt.
• IRS Form 941 -- Employer’s Quarterly Federal Tax Return. This form can be used as IRS documentation showing the Tax ID and Legal Business Name of the entity. This form can only be accepted if it is pre-printed from the IRS with the Tax ID number and Legal Business Name.
• Joint venture -- A business undertaking involving a one-time grouping of two or more entities. Although a joint venture is treated like a partnership for Federal Income tax purpose, it is different form the latter as it does not involve a continuing relationship among the parties. Joint ventures are, in a sense, short-term partnerships. In a joint venture where there is no transfer of legal title of assets, no change of ownership (CHOW) occurs.
• Legal Business Name -- The name of a business that is reported to the Internal Revenue Service (IRS).
• Managing employee -- A managing employee is defined as a general manager, business manager, administrator, director, or other individual that exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operation of the provider or supplier, either under contract or through some other arrangement, whether or not the individual is a W-2 employee of the provider or supplier. For purposes of this definition of managing employee, this includes, but is not limited to, a hospice or skilled nursing facility administrator and a hospice or skilled nursing facility medical director.
• Managing organization -- A managing organization is one that exercises operational or managerial control over the provider or conducts the day-to-day operations of the provider. The organization need not have an ownership interest in the provider in order to qualify as a managing organization. For instance, the organization could be a management services organization under contract with the provider to furnish management services for one of the provider's practice locations.
• Medical Director -- A physician, licensed to practice medicine in the jurisdiction in which the OTP is located, who assumes responsibility for administering all medical services performed by the program, either by performing them directly or by delegating specific responsibility to authorized program physicians and healthcare professionals functioning under the medical director’s direct supervision.
• Medicare identification number -- For Part A providers, the Medicare identification number is the CMS Certification Number (CCN). For Part B suppliers the Medicare identification number is the Provider Transaction Access Number (PTAN).
• Mobile facility/portable unit -- These terms apply when a service that requires medical equipment is provided in a vehicle or the equipment for the service is transported to multiple locations within a geographic area. The most common types of mobile facilities/portable units are:
• Mobile independent diagnostic testing facilities
• Portable X-ray units
• Portable mammography units
• Mobile clinics
Note: Physical therapists and other medical practitioners (e.g., physicians, nurse practitioners, physician assistants) who perform services at multiple locations (e.g., house calls, assisted living facilities) are not considered to be mobile facilities/portable units.
• Municipality -- This term applies to a city or town that has corporate status or local government or the governing body of a municipality.
• National Provider Enrollment Eastern Region (NPEAST) Durable Medical Equipment, Prosthetics, Orthotics and Supplies Enrollment (DMEPOS) -- The NPEAST DMEPOS contractor, replaces the National Supplier Clearinghouse Medicare Administrative Contractor (NSC MAC) as the single organizational entity responsible for issuing or revoking Medicare supplier billing privileges for suppliers of DMEPOS in the Eastern Region of the United States.
• National Provider Enrollment Western Region (NPWEST) Durable Medical Equipment, Prosthetics, Orthotics and Supplies Enrollment (DMEPOS) -- The NPWEST DMEPOS contractor, replaces the National Supplier Clearinghouse Medicare Administrative Contractor (NSC MAC) as the single organizational entity responsible for issuing or revoking Medicare supplier billing privileges for suppliers of DMEPOS in the Western Region of the United States.
• National Provider Identifier -- The standard unique health identifier for health care providers (including Medicare suppliers) and is assigned by the National Plan and Provider Enumeration System (NPPES).
• National Supplier Clearinghouse Medicare Administration Contractor (NSC-MAC) -- The nationwide DMEPOS enrollment contractor (referred to as the NSC or the NSC-MAC).
• Non-Certified Provider/Supplier -- Part B providers/suppliers who are not required to have a State Survey. The applications are processed by the contractor and do not need to be approved by the SA/SOG. These providers include: physicians, physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, anesthesiology assistant, certified nurse midwife, clinical social worker, clinical psychologist, registered dietician/nutrition professional and organizations consisting of physicians and or non-physician practitioners.
• Non-participating provider -- A provider who does not wish to sign the participation agreement.
• Officer – Means an officer of a corporation, regardless of whether the provider or supplier is a non-profit entity.
• Operational -- The provider or supplier has a qualified physical practice location, is open to the public for the purpose of providing health care related services, is prepared to submit valid Medicare claims; and is properly staffed, equipped, and stocked (as applicable, based on the type of facility or organization, provider or supplier specialty, or the services or items being rendered) to furnish these items or services.
• Opt out provider -- A provider that has been approved to withdraw (opt out) from the Medicare Program.
• Ordering physician or ordering non-physician practitioner -- CMS-covered physician or non-physician practitioner who may order medical services for Medicare beneficiaries. The DVA, DOD or PHS must employ the individual. The DVA, DOD or PHS must have an active enrollment record in PECOS. The physician or non-physician practitioner will not be reimbursed for services rendered.
• Other eligible professional -- As defined in 1848(k)(3)(B) of the Social Security Act – means: (i) a physician; (ii) a practitioner described in section 1842(b)(18)(C); (iii) a physical or occupational therapist or a qualified speech-language pathologist; or (iv) a qualified audiologist (as defined in section 1861(ll)(3)(B)). (For (ii), “practitioner” is defined in section 1842(b)(18)(C) as a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, or registered dietitian or nutrition professional.)
• Owner (Ownership) -- Any individual or entity that has any partnership interest in, or that has 5 percent or more direct or indirect ownership of, the provider or supplier as defined in sections 1124 and 1124(A) of the Social Security Act.
• Ownership or investment interest -- Means an ownership or investment interest in the entity that may be through equity, debt, or other means, and includes an interest in an entity that holds an ownership or investment interest in any entity that furnishes designated health services.
• Paramedic ALS Intercept Services (PI) -- Per 42 CFR §414.605, EMT Paramedic services furnished by an entity that does not furnish the ground transportation, provided that the services meet the requirements in 42CFR410.40(c); PI typically involves an arrangement between a BLS ambulance supplier and an ALS ambulance supplier, whereby the latter provides the ALS services and the BLS supplier provides the transportation component.
• Participating provider -- Must sign the participation agreement in order to be participating.
• Partnership -- Means an association of two or more persons/entities who carry on a business for profit. Each partner in a partnership is an owner. If A and B form the "Y Partnership" and each contributes $50,000 to start up the business, each partner owns one-half of Y.
• PECOS -- Provider Enrollment Chain and Organization System. A system that is used by CMS for physician/non-physician practitioners and organizations that have been approved. This system is used to store and update provider/supplier information.
• Physician -- Means a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor, as defined in section 1861(r) of the Social Security Act.
• Physician or non-physician practitioner organization -- Any physician or non-physician practitioner entity that enrolls in the Medicare program as a sole proprietorship or organization entity.
• Physician-owned hospital -- (under 42 CFR § 489.3) means any participating hospital in which a physician, or an immediate family member of a physician, has a direct or indirect ownership or investment interest, regardless of the percentage of that interest.
• Physician owner or investor -- (under 42 CFR § 411.362(a)) means a physician (or an immediate family member) with a direct or an indirect ownership or investment interest in the hospital.
• Program Sponsor -- The person named in the application for certification described in 42 CFR § 8.11(b) is responsible for the operation of the opioid treatment program and who assumes responsibility for all its employees, including any practitioners, agents, or other persons providing medical, rehabilitative, or counseling services at the program or any of its medication units. The program sponsor need not be a licensed physician but shall employ a licensed physician for the position of medical director.
• Prospective provider -- Means any entity specified in the definitions of “provider” in 42 CFR 498.2 that seek to be approved for coverage of its services by Medicare.
• Prospective supplier -- Means any entity specified in the definition of “supplier” in 42 CFR 405.802 that seek to be approved for coverage of its services under Medicare.
• Provider -- As defined at 42 CFR 400.202 and generally means a hospital, critical access hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility (CORF), home health agency or hospice, that has in effect an agreement to participate in Medicare; or a clinic, rehabilitation agency, or public health agency that has in effect a similar agreement but only to furnish outpatient physical therapy or speech pathology services; or community mental health center that has in effect a similar agreement but only to furnish partial hospitalization services.
• Provider Access Transaction Number (PTAN) -- Providers/suppliers will be issued a PTAN to access their IVR data and may also be used to identify their NPI number on the NPI crosswalk. The PTAN is what was previously referred to as the Medicare Identification Number, Legacy Number and/or OSCAR number.
• Reassignee -- Any provider or supplier that is permitted to bill and receive payment under a reassignment in accordance with existing Medicare policy.
• Reassignment -- An individual physician or non-physician practitioner, except physician assistants, has granted a clinic or group practice the right to receive payment for the practitioner’s services.
• Referring Physician or Non-Physician Practitioner -- CMS covered physician or Non-Physician Practitioner who may refer Medicare beneficiaries to other providers or suppliers. The DVA, DOD or PHS must employ the individual. The DVA, DOD or PHS must have an active enrollment record in PECOS. The physician or non-physician practitioner will not be reimbursed for services rendered.
• Reject/Rejected -- The provider or supplier’s enrollment application was not processed due to incomplete information or that additional information or corrected information was not received from the provider or supplier in a timely manner.
• Retrospective Billing Privileges -- Means that certain Part B suppliers can bill retrospectively for up to 30 or 90 days prior to their enrollment effective date as described in 42 CFR 424.520(d) and 424.521(a).
• Return/Returned -- Means a non-application. For example, if the application was submitted to the wrong contractor, the contractor can return the application immediately.
• Revoke/Revocation -- The provider or supplier’s billing privileges are terminated.
• Sole-owner -- A business structure in which an individual and his/her company are considered separate entities for tax and liability purposes. A sole ownership is a company that is registered with the state as a limited liability company, corporation, professional association, etc. The owner pays income tax separately for the company.
• Sole proprietor -- A business structure in which an individual and his/her company are considered a single entity for tax and liability purposes. A sole proprietorship is a company, which is not registered with the state as a limited liability company, corporation, etc. The owner is personally liable for all of the business debts and reports any business profits or losses on their individual tax return.
• Specialty Care Transport (SCT) -- Inter-facility transportation of a critically injured or ill beneficiary by a ground ambulance vehicle including medically necessary suppliers and services at a level of service beyond the scope of the EMT-Paramedic, SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area.
• Supervision
• Personal Supervision -- a physician must be in attendance in the room during the performance of the procedure.
• Direct Supervision -- the physician must be present in the office suite and immediately available to provide assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.
• General Supervision -- the procedure is provided under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure. General supervision also includes the responsibility that the non-physician personnel who perform the tests are qualified and properly trained and that the equipment is operated properly, maintained, calibrated and that necessary supplies are available.
• Supplier – A supplier means (for purposes of 42 CFR Part 424, subpart P) individuals and entities that qualify as suppliers under § 400.202, physical therapists in private practice, occupational therapists in private practice, and speech language pathologists.
• Tax Identification Number -- The number (either the Social Security Number (SSN) or Employer Identification Number (EIN)) the individual or organization uses to report tax information to the IRS.
• Telemedicine -- Providers evaluate, diagnose, and treat patients in remote locations using telecommunications technology. This includes teleradiology, radiologists reading for a supplier in another state, which is used in inter-jurisdictional reassignments, and telehealth- the exchange of medical information from one site to another through electronic communication to improve a patient's health.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
