Maryland-National Capital Homecare Association

Homecare Definitions

Definitions and Other Useful Information


Confused by some healthcare definitions? The information below will help you better understand the meaning of various homecare terms.


Approved Amount: The fee Medicare sets as reasonable for a covered medical service. It may be less than the actual amount charged. Approved amount is sometimes called "approved charge."


Durable Medical Equipment: Medical equipment that is ordered by a doctor for use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds.


Centers for Medicare & Medicaid Services (CMS) formerly known as Health Care Financing Administration (HCFA): The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Program, and works to make sure that the beneficiaries in these programs have access to high quality health care.


Homebound: Normally unable to leave home. Leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber.


Home Health Care: Skilled nursing care and certain other health care that you get in your home for the treatment of an illness or injury.


Medicare: A health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (people with permanent kidney failure who need dialysis or a transplant).


Medicaid: A joint Federal and State program that helps with medical costs for some people with low incomes. Programs vary from State to State, but most health care costs are covered if you qualify for both Medicare and Medicaid. 


Medically Necessary: Services or supplies that:

•    are proper and needed for the diagnosis, or treatment of your medical condition;

•    are provided for the diagnosis, direct care, and treatment of your medical condition;

•    meet the standards of good medical practice in the medical community of your local area; and

•    are not mainly for the convenience of you or your doctor.


Out-of-Pocket Costs: Health care costs that you must pay on your own because they are not covered by Medicare.


Plan Of Care: A plan written by your doctor that describes what kind of services and care you must receive for your health problem.


Provider: A doctor, hospital, health care professional, or health care facility.


Skilled Nursing Care: A level of care that must be given or supervised by licensed nurses and is under the general direction of a doctor. All of your needs are taken care of with this type of service, including giving direct services. Examples of skilled nursing care are: getting intravenous injections, tube feeding, oxygen to help you breathe, and changing sterile dressings on a wound. Any service that could be safely performed by an average non-medical person (pr one's self) without the direct supervision of a licensed nurse is not covered.

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