Glossary

IBNR

Incurred but not received

ICD-10 Codes

International Classification of Diseases10th Revision Codes: Diagnosis Codes used more prominently internationally than in the United States.

ICD-9 Codes

International Classification of Diseases 9th Revision Codes: Diagnosis Codes used in the United States.

ICU

Issue and Containment Utility (Plexis): An in house system that contains and tracks any requests, bugs, or issues relating to a client. ICU also contains actual and estimated hours spent on an issue along with who is working on it and any updates.

In-Plan Services

Services that are covered under the state Medicaid plan and included in the patient’s managed care contract and/or are furnished by a participating provider.

Incidence

In epidemiology, the number of cases of disease, infection, or some other event having their onset during a prescribed period of time in relation to the unit of population in which they occur. Incidence measures morbidity or other events as they happen over a period of time. Examples include the number of accidents occurring in a manufacturing plant during a year in relation to the number of employees in the plant, or the number of cases of mumps occurring in a school during a month in relation to the number of pupils enrolled in the school. It usually refers only to the number of new cases, particularly of chronic diseases. Hospitals also track certain risk management or quality problems with a system called incidence reporting.

Incurred But Not Reported (IBNR)

Refers to a financial accounting of all services that have been performed but, as a result of a short period of time, have not been invoiced or recorded. Estimates of costs for medical services provided for which a claim has not yet been filed. Refers to claims which reflect services already delivered, but, for whatever reason, have not yet been reimbursed. These are bills “in the pipeline.” This is a crucial concept for proactive providers who are beginning to explore arrangements that put them in the role of adjudicating claims–as the result, perhaps, of operating in a sub-capitated system. Failure to account for these potential claims could lead to some very bad decisions. Good administrative operations have fairly sophisticated mathematical models to estimate this amount at any given time.

Incurred Claims

All claims with dates of service within a specified period.

Incurred Claims Loss Ratio

Incurred claims divided by premiums

Indemnify

To make good a loss.

Indemnity

Managed care, particularly HMO and capitation, has evolved away from the indemnity method. Yet, many people are still covered under indemnity plans. Insurance program in which covered person is reimbursed for covered expenses. Health insurance benefits provided in the form of cash payments rather than services. An indemnity insurance contract usually defines the maximum amounts which will be paid for covered services. Indemnity insurance plans may have a PPO option, UR and case management features, or include a network or other preferred provider restrictions, but, will not have an HMO plan. Indemnity is the traditional form of insurance.

Indemnity Carrier

Usually an insurance company or insurance group that provides marketing, management, claims payment and review, and agrees to assume risk for its subscribers at some pre-determined rate.

Indemnity Plan (Indemnity Health Insurance)

A plan which reimburses physicians for services performed, or beneficiaries for medical expenses incurred. Such plans are contrasted with group health plans, which provide service benefits through group medical practice.

Independent Practice Association or Organization (IPA, IPO)

A delivery model in which the HMO contracts with a physician organization, which in turn contracts with individual physicians. The IPA physicians practice in their own offices and continue to also see their FFS patients. The HMO reimburses the IPA on a capitated basis; however, the IPA may reimburse the physicians on an FFS or capitated basis.

Individual (or Independent ) Practice Association (IPA)

An organized form of prepaid medical practice in which participating physicians remain in their independent office settings, seeing both enrollees of the IPA and private-pay patients. Participating physicians may be reimbursed by the IPA on a fee-for-service basis or a capitation basis. Sometimes thought of as an HMO model in which the HMO contracts with a physician organization that in turn contracts with individual physicians. The IPA physicians provide care to HMO members from their private offices and continue to see their fee-for-service patients.

Individual Plans

A type of insurance plan for individuals and their dependents who are not eligible for coverage through an employer group coverage.

Inpatient Care

Care given a registered bed patient in a hospital, nursing home or other medical or post acute institution.

Integrated Delivery Systems (IDS, ISN)

Many different, but similar, definitions exist for IDS. IDS, as an entity, does not have to abide by strict regulations as does an HMO. When an IDS offers a health plan, however, it must then abide by the requirements of the state and federal government for health plans, insurance companies or HMOs. Without owning a health plan product, an IDS will usually abide by the regulations that govern its separate businesses, that is, regulations governing hospitals, clinics and physicians. An IDS can be a financial or contractual arrangement between health providers (usually hospitals and doctors) to offer a comprehensive range of health care services through a separate legal entity operating, at least for these purposes, as a single health care delivery system. IDS can be a network of organizations usually including hospitals and physician groups, that provides or arranges to provide a coordinated continuum of services to a defined population and is held both clinically and fiscally accountable for the outcomes of the populations served. IDS can also be a healthcare provider organization which vertically integrates physician, hospital, and, usually, also health plan businesses in some manner in order to establish a full continuum of care, seamless of delivery of services and the ability to manage care under new reimbursement arrangements. Also called delivery system, vertically integrated system, horizontally integrated system, health delivery network, accountable health plan, and other names.

Interface

A means of communication between two computer systems, two software applications or two modules. Real time interface is a key element in healthcare information systems due to the need to access patient care information and financial information instantaneously and comprehensively. Such real time communication is the key to managing health care in a cost effective manner because it provides the necessary decisionmaking information for clinicians, providers and payers.

Internal Medicine

Generally, that branch of medicine that is concerned with diseases that do not require surgery, specifically, the study and treatment of internal organs and body systems; it encompasses many subspecialties; internists, the doctors who practice internal medicine, often serve as family physicians to supervise general medical care.

International Classification of Diseases (ICD-9-CM)

This is the universal coding method used to document the incidence of disease, injury, mortality and illness. A diagnosis and procedure classification system designed to facilitate collection of uniform and comparable health information. The ICD-9-CM was issued in 1979. This system is used to group patients into DRGs, prepare hospital and physician billings and prepare cost reports. Classification of disease by diagnosis codified into six-digit numbers. See also coding.

Intervention Strategy

A generic term used in public health to describe a program or policy designed to have an impact on an illness or disease. Hence a mandatory seat belt law is an intervention designed to reduce automobile-related fatalities.