62J.805 DEFINITIONS.
331 words·~2 min read·
/mn/chapter-62/62j-805A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
62J.805 DEFINITIONS.
§
Subdivision 1. Application.
For purposes of sections 62J.805 to 62J.808 , the following terms have the meanings given.
§
Subd. 2. Billing error.
"Billing error" means an error in a bill from a health care provider to a patient for health treatment or services that affects the amount owed by the patient according to that bill. Billing error includes but is not limited to
(1)miscoding a health treatment or service,
(2)an error in determining whether a health treatment or service is covered under the patient's health plan, or
(3)an error in determining the cost-sharing owed by the patient.
§
Subd. 3. Group practice.
"Group practice" has the meaning given to health care provider group practice in section 145D.01, subdivision 1 .
§
Subd. 4. Health care provider.
"Health care provider" means:
(1)a health professional who is licensed or registered by the state to provide health treatment and services within the professional's scope of practice and in accordance with state law;
(2)a group practice; or
(3)a hospital.
§
Subd. 5. Health plan.
"Health plan" has the meaning given in section 62A.011 , subdivision 3.
§
Subd. 6. Hospital.
"Hospital" means a health care facility licensed as a hospital under sections 144.50 to 144.56 .
§
Subd. 7. Medically necessary.
"Medically necessary" means:
(1)safe and effective;
(2)not experimental or investigational, except as provided in Code of Federal Regulations, title 42, section 411.15 (o);
(3)furnished in accordance with acceptable medical standards of medical practice to diagnose or treat the patient's condition, or to improve the function of a malformed body member;
(4)furnished in a setting appropriate to the patient's medical need and condition;
(5)ordered and furnished by qualified personnel;
(6)meets, but does not exceed, the patient's medical need; and
(7)is at least as beneficial as an existing and available medically appropriate alternative.
§
Subd. 8. Payment.
"Payment" includes co-payments and coinsurance and deductible payments made by a patient.