Centers for Medicare and Medicaid (CMS) - the federal agency that runs the Medicare program and works with states to run the Medicaid program.

Certificate of Coverage (COC) - a description of the benefits included in an insurance company's plan.  The certificate of coverage is required by state laws and describes the coverage provided under the contract issued to the employer.

Charity care - Free or reduced-fee care for patients who have financial hardship.

Children's Health Insurance Program (CHIP) - a federal program jointly funded by states and the federal government that provides medical insurance coverage for children not covered by state Medicaid-funded programs.

Claim - the bill the hospital sends to the insurance company on behalf of the patient.

Clinic - an area in a hospital or separate building that treats regularly scheduled or walk-in patients for non-emergency care.

Coding of claims – a process through which diagnoses and procedures from the patient's medical record are translated into numbers (codes).  These numbers are then billed to the insurance company so their computers can process the patient’s claim for payment.

Co-insurance - a cost-sharing provision of an insurance plan that requires the beneficiary to pay a percentage of the charges out-of-pocket.  Beneficiaries may owe co-insurance in addition to a deductible.

Co-insurance days – Medicare coverage from day 61 to day 90 of continuous inpatient hospitalization.  The patient is responsible for paying for part of those days.  After the 90th day, the patient enters their lifetime reserve days.

Collection agency - a business that contracts with the hospital to collect money from guarantors for unpaid bills.

Consolidated Omnibus Budget Reconciliation Act (COBRA) - a federal law that, among other provisions, requires employers with 20 or more eligible employees to offer continued health insurance coverage under their group plan to terminated employees and their dependents.  Typically, COBRA makes continued coverage available for up to 18 or 36 months.  COBRA enrollees may be required to pay 100 percent of the premium plus an administrative fee.

Coordination of Benefits (COB) – an agreement that determines which insurance company is primarily responsible for payment when a patient is covered under more than one insurance plan.

Co-pay - a cost-sharing provision of an insurance plan that requires the beneficiary to pay a fixed dollar amount for services out-of-pocket.

Covered days - days of the hospital stay that insurance pays for in full or in part.

Date of service (DOS) – time period during which services were provided.

Deductible –a cost-sharing provision of an insurance plan that requires the beneficiary to pay a specified amount of charges out-of-pocket before insurance begins to cover any care.  This amount must typically be paid (met) each year.  See also beneficiary/patient liability.

Denial – a decision by insurance not to pay for care the hospital provided to the patient.  Insurance may deny part or all of a claim based on a lack of medical necessity or pre-admission approval/certification, terminated coverage, or other reasons.  Denied amounts may be charged to the guarantor.  See also appeal.

Diagnosis code - a billing code that describes the patient's illness.

Diagnosis-Related Groups (DRGs) – a system of classifying inpatient admissions on the basis of diagnosis for purposes of paying hospitals.  The DRG system classifies admissions into groups based on the principal diagnosis, type of surgical procedure, presence or absence of complications, and other relevant indicators.

Duplicate Coverage Inquiry (DCI) – a request by an insurance company to another insurance company to determine whether other coverage exists.  See also coordination of benefits.

Durable Medical Equipment (DME) – re-usable medical equipment ordered by a doctor for use at home.

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