Glossary IC – IN

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ICD-9 False Claims – The falsification of ICD-9 codes in claim forms submitted to Government Payors. See ICD-9-CM International Classification of Diseases in this Glossary.

ICD-9 Fraud – The falsification of ICD-9 codes in claim forms submitted to Government Payors. See ICD-9-CM International Classification of Diseases in this Glossary.

ICD-9 Code Fraud – The falsification of ICD-9 codes in claim forms submitted to Government Payors. See ICD-9-CM International Classification of Diseases in this Glossary.

ICD-9-CM International Classification of Diseases – this is a system of coding diseases according to signs, symptoms, injuries, diseases, and conditions. ICD-9 codes (such as e.g. CPT) of edits will typically reject them. As a result, when CPT codes are falsified, ICD-9 codes are usually falsified as well. See Upcoding in this Glossary.

Incident to Fraud – See Incident to Billing in this Glossary.

Incident to billing – historically, in the office based setting, mid-level provider (Nurse Practitioner and Physician Assistant) reimbursement has been for services that are “incident to” a physician’s service. This is most often referred to as billing (Medicare Part B) for “incident to” services. As long as certain criteria are met, the mid-level provider services may be billed by the employer as if the physician had performed them at 100 percent (100 %) of the physician fee schedule. Fraud commonly occurs where services are rendered but the physician is not even on the premises.

Incident to Medicare Fraud – See Incident to Billing in this Glossary.

Innovator Multiple Source Drug – relevant to both Medicaid and Medicare outpatient prescriptions drug coverage reimbursement, this classification of a drug is defined as all Covered Outpatient Drugs approved under a New Drug Application (NDA), Product License Approval (PLA), Establishment License Approval (ELA) or Antibiotic Drug Approval (ADA). A Covered Outpatient Drug marketed by a cross-licensed producer or distributor under the approved NDA is included as an innovator multiple source drug when the drug product meets this definition. An Innovator Multiple Source drug also includes an authorized generic drug including any labelers operating under the NDA. See Generic Drug in this Glossary.