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Glossary

Glossary

This glossary explains terms found on the cms.hhs.gov web site, but it is not a legal document.

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N

Term Definition
NATIONAL ASSOCIATION OF HEALTH DATA ORGANIZATIONS

A group that promotes the development and improvement of state and national health information systems.

NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS

An association of the insurance commissioners of the states and territories.

NATIONAL ASSOCIATION OF STATE MEDICAID DIRECTORS

An association of state Medicaid directors. NASMD is affiliated with the American Public Health Human Services Association (APHSA).

NATIONAL CENTER FOR HEALTH STATISTICS

A federal organization within the CDC that collects, analyzes, and distributes health care statistics. The NCHS maintains the ICD-n-CM codes.

NATIONAL COMMITTEE FOR QUALITY ASSURANCE

An organization that accredits managed care plans, or Health Maintenance Organizations (HMOs). In the future, the NCQA may play a role in certifying these organizations' compliance with the HIPAA A/S requirements. The NCQA also maintains the Health Employer Data and Information Set (HEDIS).

NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA)

A non-profit organization that accredits and measures the quality of care in Medicare health plans. NCQA does this by using the Health Employer Data and Information Set (HEDIS) data reporting system. (See Health Employer Data and Information Set (HEDIS).)

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

A Federal advisory body within HHS that advises the Secretary regarding potential changes to the HIPAA standards.

NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS

An ANSI-accredited group that maintains a number of standard formats for use by the retail pharmacy industry, some of which have been adopted as HIPAA standards.

NATIONAL COVERAGE ANALYSES (NCA)

Numerous documents support the national coverage determination process. They include tracking sheets to inform the public of the issues under consideration and the status (i.e., Pending, Closed) of the review, information about and results of MEDCAC (formerly know as MCAC) meetings, Technology Assessments, and Decision Memoranda that announce CMS's intention to issue an NCD. These documents, along with the compilation of medical and scientific information currently available, any FDA safety and efficacy data, clinical trial information, etc., provide the rationale behind the evidence-based NCDs.

NATIONAL COVERAGE DETERMINATIONS (NCDS)

An NCD sets forth the extent to which Medicare will cover specific services, procedures, or technologies on a national basis. Medicare contractors are required to follow NCDs. If an NCD does not specifically exclude/limit an indication or circumstance, or if the item or service is not mentioned at all in an NCD or in a Medicare manual, it is up to the Medicare contractor to make the coverage decision (see LCD). Prior to an NCD taking effect, CMS must first issue a Manual Transmittal, CMS ruling, or Federal Register Notice giving specific directions to our claims-processing contractors. That issuance, which includes an effective date and implementation date, is the NCD. If appropriate, the Agency must also change billing and claims processing systems and issue related instructions to allow for payment. The NCD will be published in the Medicare National Coverage Determinations Manual. An NCD becomes effective as of the date listed in the transmittal that announces the manual revision.

NATIONAL COVERAGE POLICY

A policy developed by CMS that indicates whether and under what circumstances certain services are covered under the Medicare program. It is published in CMS regulations, published in the Federal Register as a final notice, contained in a CMS ruling, or issued as a program instruction.

NATIONAL DRUG CODE

A medical code set maintained by the Food and Drug Administration that contains codes for drugs that are FDA-approved. The Secretary of HHS adopted this code set as the standard for reporting drugs and biologics on standard transactions.

NATIONAL EMPLOYER ID

A system for uniquely identifying all sponsors of health care benefits.

NATIONAL HEALTH INFORMATION INFRASTRUCTURE

This is a healthcare-specific lane on the Information Superhighway, as described in the National Information Infrastructure (NII) initiative. Conceptually, this includes the HIPAA A/S initiatives.

NATIONAL IMPROVEMENT PROJECTS

HCQIP projects developed by a group consisting of representatives of some or all of the following groups: CMS, Public Health Service, Networks, renal provider, and consumer communities. The object is to use statistical analysis to identify better patterns of care and outcomes, and to feed the results of the analysis back into the provider community to improve the quality of care provided to renal Medicare beneficiaries. Each project will have a particular clinical focus.

NATIONAL MEDIAN CHARGE

The national median charge is the exact middle amount of the amounts charged for the same service. This means that half of the hospitals and community mental health centers charged more than this amount and the other half charged less than this amount for the same service.

NATIONAL PATIENT ID

A system for uniquely identifying all recipients of health care services. This is sometimes referred to as the National Individual Identifier (NII), or as the Healthcare ID.

NATIONAL PAYER ID

A system for uniquely identifying all organizations that pay for health care services. Also known as Health Plan ID, or Plan ID.

NATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM (NPPES)

The system that uniquely identifies a health care provider (as defined at 45 CFR 160.103) and assigns it an NPI. The system is designed with the future capability to also enumerate health plans once the Secretary has adopted a standard unique health identifier for health plans.

NATIONAL PROVIDER IDENTIFIER (NPI)

The name of the standard unique health identifier for health care providers that was adopted by the Secretary in January 2004.

NATIONAL STANDARD FORMAT

Generically, this applies to any nationally standardized data format, but it is often used in a more limited way to designate the Professional EMC NSF, a 320-byte flat file record format used to submit professional claims.

NATIONAL STANDARD PER VISIT RATES

National rates for each 6 home health disciplines based on historical claims data. Used in payment of LUPAs and calculation of outliers.

NATIONAL UNIFORM BILLING COMMITTEE

An organization, chaired and hosted by the American Hospital Association, that maintains the UB-92 hardcopy institutional billing form and the data element specifications for both the hardcopy form and the 192-byte UB-92 flat file EMC format. The NUBC has a formal consultative role under HIPAA for all transactions affecting institutional health care services.

NATIONAL UNIFORM CLAIM COMMITTEE

An organization, chaired and hosted by the American Medical Association, that maintains the HCFA-1500 claim form and a set of data element specifications for professional claims submission via the HCFA-1500 claim form, the Professional EMC NSF, and the X12 837. The NUCC also maintains the Provider Taxonomy Codes and has a formal consultative role under HIPAA for all transactions affecting non-dental non-institutional professional health care services.

NCPDP BATCH STANDARD

A NCPDP format for use by low-volume dispensers of pharmaceuticals, such as nursing homes. The Secretary of HHS adopted Version 1.0 of this format as a standard transaction.

NCPDP TELECOMMUNICATION STANDARD

An NCPDP standard designed for use by high-volume dispensers of pharmaceuticals, such as retail pharmacies. Use of Version 5.1 of this standard has been mandated under HIPAA.

NCPDP TELECOMMUNICATION STANDARD

A NCPDP format designed for use by high-volume dispensers of pharmaceuticals, such as retail pharmacies. The Secretary of HHS adopted Version 5.1 of this format as a standard transaction.

NEBULIZERS

Equipment to give medicine in a mist form to your lungs.

NEGLECT

When care takers do not give a person they care for the goods or services needed to avoid harm or illness.

NETWORK

A group of doctors, hospitals, pharmacies, and other health care experts hired by a health plan to take care of its members.

NNPI ENUMERATOR

An organization under contract with the Centers for Medicare & Medicaid Services whose responsibility includes, but is not limited to, the processing of applications for, and deactivations of, National Provider Identifiers (NPIs), and the processing of changes of information to health care providers' records contained in the National Plan and Provider Enumeration System (NPPES). The NPI Enumerator assists health care providers in taking the above actions and resolves any problems in the processing of those actions.

NO-FAULT INSURANCE

No-fault insurance is insurance that pays for health care services resulting from injury to you or damage to your property regardless of who is at fault for causing the accident.

NONCONTRIBUTORY OR DEEMED WAGE CREDITS

Wages and wages in kind that were not subject to the HI tax but are deemed as having been. Deemed wage credits exist for the purposes of (1) determining HI program eligibility for individuals who might not be eligible for HI coverage without payment of a premium were it not for the deemed wage credits; and (2) calculating reimbursement due the HI trust fund from the general fund of the Treasury. The first purpose applies in the case of providing coverage to persons during the transitional periods when the HI program began and when it was expanded to cover federal employees; both purposes apply in the cases of military service wage credits (see "Military service wage credits" and "Quinquennial military service determinations and adjustments") and deemed wage credits granted for the internment of persons of Japanese ancestry during World War II.

NON-COVERED SERVICE

The service:

  • does not meet the requirements of a Medicare benefit category,
  • Is statutorily excluded from coverage on ground other than 1862(a)(1), or
  • is not reasonable and necessary under 1862 (a)(1).
NON-ENTITY ASSETS

Assets that are held by an entity but are not available to the entity. These are also amounts that, when collected, cannot be spent by the reporting entity.

NON-FEDERAL AGENCY

A State or local government agency that receives records contained in a system of records from a Federal agency to be used in a matching program.

NON-FORMULARY DRUGS

Drugs not on a plan-approved list.

NONPARTICIPATING PHYSICIAN

A doctor or supplier who does not accept assignment on all Medicare claims. (See Assignment.)

NORTH CAROLINA HEALTHCARE INFORMATION AND COMMUNICATIONS ALLIANCE

An organization that promotes the advancement and integration of information technology into the health care industry.

NOTICE OF INTENT

A document that describes a subject area for which the Federal Government is considering developing regulations. It may describe the presumably relevant considerations and invite comments from interested parties. These comments can then be used in developing an NPRM or a final regulation.

NOTICE OF PROPOSED RULEMAKING

A document that describes and explains regulations that the Federal Government proposes to adopt at some future date, and invites interested parties to submit comments related to them. These comments can then be used in developing a final regulation.

NPI REGISTRY

A publicly available, Internet-based real-time query database that displays publicly available health care provider data from the NPPES in response to a user?s query.

NPLANID

A term used by CMS for a proposed standard identifier for health plans. CMS had previously used the terms PayerID and PlanID for the health plan identifier.

NUBC EDI TAG

The NUBC EDI Technical Advisory Group, which coordinates issues affecting both the NUBC and the X12 standards.

NURSE PRACTITIONER

A nurse who has 2 or more years of advanced training and has passed a special exam. A nurse practitioner often works with a doctor and can do some of the same things a doctor does.

NURSING FACILITY

A facility which primarily provides to residents skilled nursing care and relate services for the rehabilitation of injured, disabled, or sick persons, or on a regular basis, health related care services above the level of custodial care to other than mentally retarded individuals.

NURSING FACILITY

A facility which primarily provides skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or on a regular basis, health related care services above the level of custodial care to other than mentally retarded individuals.

NURSING HOME

A residence that provides a room, meals, and help with activities of daily living and recreation. Generally, nursing home residents have physical or mental problems that keep them from living on their own. They usually require daily assistance.

NUTRITION

Getting enough of the right foods with vitamins and minerals a body needs to stay healthy. Malnutrition, or the lack of proper nutrition, can be a serious problem for older people.


*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.


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Page Last Modified: 5/14/06 11:45 AM
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