Acronym |
Term |
---|---|
A&R |
Audit & Reimbursement |
AAFP |
American Academy of Family Physicians |
AAHA |
American Association of Homes for the Aging |
AAHP |
American Association of Health Plans |
AAMC |
Association of American Medical Colleges |
AAO |
American Academy of Ophthalmology |
AAP |
American Academy of Pediatrics |
AAPC |
American Association of Professional Coders |
AAPCC |
Adjusted Average Per Capita Cost |
ABA |
American Bar Association |
ABN |
Advanced Beneficiary Notice |
ABR |
American Board of Radiology |
ABS |
Annual Beneficiary Summary |
AC |
Actual Charge |
ACA |
Patient Protection & Affordable Care Act (also PPACA) |
ACC |
Automated Change Control |
ACE |
Affiliated Covered Entity |
ACE |
(Carrier) Automated Claims Examination |
ACER |
Annual Contractor Evaluation Report |
ACMP |
Audit/Civil Monetary Penalties |
ACMS |
Advanced Cost Management Systems |
ACO |
Accountable Care Organization |
ACR |
Adjusted Community Rate |
AD |
Admitting Diagnosis |
ADA |
American Dental Association |
ADA |
American Dietetic Association |
ADA |
Americans with Disabilities Act of 1990 |
ADAMHA |
Alcohol, Drug Abuse & Mental Health Administration |
ADG |
Ambulatory Diagnostic Group |
ADG-HOSDOM |
Ambulatory Diagnostic Group Hospital Dominant |
ADHA |
American Dental & Hygienists Association |
ADJ |
Adjusted Claim |
ADMC |
Advance Determination of Medicare Coverage |
ADT |
Admission/Discharge Transfer |
AFEHCT |
American Federation of Electronic Health Care Transactions |
AFEHCT |
Association for Electronic Health Care Transactions |
AFHHA |
American Federation of Home Health Agencies |
AHA |
American Hospital Association |
AHCA |
American Health Care Association |
AHIMA |
American Health Information Management Association |
AHRQ |
Agency for Healthcare Research and Quality |
AIC |
Amount In Controversy |
AKS |
Anti-Kickback Statute |
ALBN |
Amount of Last Billing Notice |
ALC |
Alternate Level of Care |
ALOS |
Average Length of Stay |
ALT |
Average Length of Treatment |
AMA |
American Medical Association |
AMASDS |
Asset Management & Automated Software Distribution System |
AMCS |
Automated Medical Coding System |
AMRA |
American Medical Records Association |
AN |
Account Number (also A/N) |
ANA |
American Nurses Association |
AOPA |
American Orthotic & Prosthetic Association |
APA |
American Pharmaceutical Association |
APA |
American Psychiatric Association |
APACHE |
Acute Physiology & Chronic Health Evaluation |
APC |
Ambulatory Payment Class |
APG |
Ambulatory Patient Group |
APG |
Ambulatory Payment Group |
APM |
Admission Pattern Monitoring |
APM |
Audit Priority Matrix |
APMA |
American Podiatric Medical Association |
APME |
Advisory Panel on Medicare Education |
APR - DRG |
all payer refined - diagnosis related groups |
APS |
Acquisition Planning Schedule |
AQI |
Audit Quality Initiative |
AQL |
Acceptable Quality Level |
AQRP |
Audit Quality Review Program |
AR |
Accounts Receivable |
ASCA |
Administrative Simplification Compliance Act |
ASCII |
American Standard Code for Information Interchange (see ANSCII) |
ASCW |
Audit Selection Criteria Worksheet |
ASH |
Assistant Secretary for Health |
ASHP |
American Society of Health Systems Pharmacists |
ASHP |
American Society of Hospital Pharmacists |
ASHRM |
American Society of Healthcare Risk Management |
ASIM |
American Society of Internal Medicine |
ASTER |
Automated System for Transaction Exception Resolution |
ATARS |
Audits Tracking & Reporting System |
BA |
Business Associate |
BAC |
Billing Action Code |
BMACS |
Part B Medicare Automated Claims Systems |
BOME |
Bureau of Medical Examiners |
BP |
Business Partner |
BPST |
Bill Processing System Test |
BQAS |
Part B Quality Assurance System |
BSR |
(Part B) Bill Summary Records |
BUR |
Billing Update Record |
CA |
Claims Analyst |
CAH |
Critical Access Hospital |
CAHPS |
Consumer Assessment of Health Plan Survey |
CAP |
Corrective Action Plan |
CAPS |
Claims Automated Processing System (SSA MBR) |
CAR |
Corrective Action Review |
CB |
Consolidated Billing |
CB |
Cost Benefit |
CBA |
Cost/Benefit Analysis |
CBR |
Cost Based Reimbursement |
CBSS |
Customer Billing Services System |
CC |
Claims Control |
CCI |
Correct Coding Initiative |
CCP |
Comprehensive Compliance Program |
CCP |
Coordinated Care Plans |
CCR |
Coverage Compliance Reviews |
CDC |
Center for Disease Control |
CDM |
(Hospital) Charge Description Master (Files) |
CDOC |
Covered Days of Care |
CDRG |
Children's Diagnosis Related Groups |
CE |
Covered Entity |
CERT |
Comprehensive Error Rate Testing |
CHAMPUS |
Civilian Health and Medical Program of the Uniformed Services |
CHC |
Community Health Center |
CHC |
Comprehensive Health Center |
CHC |
Continuous Home Care |
CHCC |
Center for Hospital & Community Care |
CHCL |
Center for Health Care Law |
CHDS |
(National) Charge Distribution System |
CHHA |
Certified Home Health Agency |
CHHC |
Continuous Home Health Care |
CHIM |
Center for Healthcare Information Management |
CHIME |
College of Healthcare Information Management Executives |
CHIP |
Child Health Insurance Program |
CHO |
Community Health Organization |
CIN |
Common Identification Number |
CIP |
Claims In Process |
CLCCP |
Comprehensive Limiting Charge Compliance Program |
CLFS |
Clinical Laboratory Fee Schedule |
CLIA |
Clinical Laboratory Improvement Act (of 1965) (Amendments 1988) |
CLIA |
Clinical Laboratory Interstate Act (or Amendments) |
CLOE |
(Carrier) Claims Only Entry System |
CLT |
Certified Lab Technician |
CMHC |
Community Mental Health Center (or Clinic) |
CMN |
Certified Medical Necessity |
CMP |
Civil Monetary Penalty |
CMPL |
Civil Monetary Penalty Law |
CMPL |
Civil Monetary Penalty Liability |
CMPTS |
Civil Monitory Penalty Tracking System |
CMS |
Centers for Medicare & Medicaid Services |
CN |
Claim Number (also C/N) |
CNH |
Community Nursing Home |
CO |
Change Order |
COBRA |
Consolidated Omnibus Budget Reconciliation Act (of 1985) |
COI |
Conflict of Interest |
COP |
Conditions of Participation |
CORF |
Comprehensive Outpatient Rehabilitation Facility |
CORTS |
Calculation of Overpayment Recovery Timeliness System |
COSO |
Commission of Sponsoring Organizations |
CP |
Claims Processing |
CPAP |
Common Provider Audit Program |
CPAS |
Claims Processing Assessment System |
CPM |
Claims Processing Manual |
CPT |
Common Procedural Terminology |
CPT |
Current Procedural Terminology |
CPT-4 |
Current Procedural Terminology, Version 4 |
CQI |
Continuous Quality Improvement |
CR |
Change Request |
CR |
Cost Report |
CRAG |
Contractor Risk Assessment Guide |
CREP |
Cost Report Evaluation Program |
CRF |
Change Request Form |
CS |
Claims Services |
DATAMED |
Medicaid Quality Control System |
DEA |
Drug Enforcement Administration (or Agency) |
DEFRA |
Deficit Reduction Act of 1984 |
DHS |
Designated Health Services (Stark Law) |
DME |
Durable Medical Equipment |
DME MAC |
Duable Medical Equipment Medicare Administrative Contractor |
DMEFS |
Durable Medical Equipment Fee Schedule |
DMEPOS |
Durable Medical Equipment Prosthetic, Orthotics, and Supplies |
DMERC |
Durable Medical Equipment Regional Carrier |
DOD |
Department of Defense |
DOJ |
Department of Justice |
DRG |
Diagnostic Related Group (patients with similar illness) |
DSCSA |
Drug Supply Chain Security Act |
DSH |
Disproportionate Share Hospital |
DSM |
Diagnostic & Statistical Manual |
DSM-IV |
Diagnostic & Statistical Manual of Mental Disorders, 4th Edition |
EACH |
Essential Access Community Hospital |
ED |
Emergency Department |
EFT |
Electronic Funds Transfer |
EFTS |
Electronic File Transfer System (GHP large volume transfer to HDC) |
EFTS |
Electronic Funds Transfer System |
EH |
Emergency Hospital |
EMB |
Eligible Medicare Beneficiary |
EMEVS |
Electronic Medicaid Eligibility Verification System |
EMT |
Emergency Medical Technician |
EMTALA |
Emergency Medical Treatment and Active Labor Act or Emergency Medical Treatment and Labor Act |
EOB |
Explanation of Benefits |
EOC |
Episode of Care |
EOMB |
Explanation of Medical Benefits |
ePHI |
Electronic Protected Health Information |
ERISA |
Employee Retirement Income Security Act |
ERM |
Enterprise Risk Management |
EVS |
Eligibility Verification System |
EWU |
Equivalent Work Unit |
F&A |
Fraud & Abuse |
FAH |
Federation of American Hospitals |
FAHS |
Federation of American Health Systems |
FAP |
Financial Assistance Policy |
FBI |
Federal Bureau of Investigation |
FCA |
False Claims Act |
FDA |
Food & Drug Administration |
FERA |
Fraud Enforcement Recovery Act |
FERPA |
Family Education Privacy Rights Act |
FFS |
Fee for Service |
FMV |
Fair Market Value |
FOIA |
Freedom of Information Act |
FQHC |
Federally Qualified Health Center |
FSGO |
Federal Sentencing Guidelines for Organizations |
FTC |
Federal Trade Commission |
FTP |
File Transfer Protocol |
GAO |
Government Accounting Office |
GCP |
Good Clinical Practice |
GHP |
Group Health Plan |
GHPPS |
Group Health Plan Payment System |
GLP |
Good Laboratory Practice |
GPO |
Group Purchasing Organization |
GSA |
General Services Administration |
HAASC |
Hospital Affiliated Ambulatory Surgical Center |
HBP |
Hospital Based Physician |
HCE |
Hybrid Covered Entity |
HCFA |
Health Care Financing Administration |
HCPC |
HCFA Common Procedure Code |
HCPCS |
Healthcare Common Procedure Coding System |
HCQII |
Health Care Quality Improvement Initiative |
HCQIP |
Health Care Quality Improvement Program |
HEAT |
Health Care Fraud Prevention and Enforcement Action Team |
HFMA |
Healthcare Financial Management Association |
HHA |
Home Health Agency |
HHABN |
Home Health Advanced Beneficiary Notice |
HHC |
Home Health Care |
HHQI |
Home Health Quality Initiative |
HHS |
Department of Health and Human Services |
HHS |
Home Health Services |
HIM |
Health Information Management |
HIPAA |
Health Insurance Portability & Accountability Act of 1996 |
HPMP |
Hospital Payment Monitoring Program |
HPMS |
Health Plan Management System |
HIPPS |
Health Insurance Prospective Payment System, a CMS payment code system |
HITECH |
Health Information Technology for Economic and Clinical Health Act |
HITRUST |
Health Information Trust Alliance |
HMO |
Health Maintenance Organization |
HMO/CMP |
HMO Competitive Medical Plan |
HMODR |
CMS Medicare Outpatient Data Review |
HRSA |
Health Resources and Services Administration |
ICAR |
Immediate Corrective Action Required |
ICD |
International Classification of Diseases |
ICD-10-CM |
International Classification of Diseases, Tenth Revision, Clinical Modification |
ICD-10-PCS |
International Classification of Diseases, 10th Revision, Procedure Coding System |
ICF |
International Classification of Functioning, Disability and Health |
ICR |
Incomplete Claims Reject |
IP/SNF |
Inpatient SNF |
IRB |
Institutional Review Board |
IRF |
Inpatient Rehabilitation Facility |
IRO |
Independent Review Organization |
IRP |
Incentive Reward Program |
JAMA |
Journal of the American Medical Association |
JC/JCAHO |
Joint Commission or Joint Commission on Accreditation of Healthcare Organizations |
L-H |
Labor Hour |
LCD |
Local Coverage Determination |
LEIE |
List of Excluded Individuals & Entities |
LoProCo |
Low Probability of Compromise (in HIPAA) |
LTC |
Long Term Care |
LTCF |
Long Term Care Facility |
LTCU |
Long Term Care Unit |
M&M |
Medicare & Medicaid |
M+C |
Medicare + Choice |
M+C NSF |
Medicare + Choice National Standard Format |
M+CO |
Medicare + Choice Organization |
MA |
Medicaid Agency |
MA |
Medicare Advantage (formerly Medicare+Choice) |
MA BSF |
Medicare Advantage Benefit Stabilization Fund |
MA-PD |
Medicare Advantage Prescription Drug Plans |
MAC |
Medicare Administrative Contractor |
MAO |
Medicare Advantage Organization |
MAPD |
Medicare Advantage Prescription Drug |
MBD |
Medicaid Beneficiary Database |
MBN |
Medicare Benefit Notice |
MCE |
Medicare Code Editor |
MCM |
Medicare Carrier Manual |
MC |
Medicare |
MCO |
Managed Care Organization |
MCPS |
Medicare (Part A) Claims Processing System (Veritus) |
MCS |
Mandatory Claim Submission System |
MDC |
Major Diagnosis Category |
MDH |
Medicare Dependent Hospital |
MDSRH |
Medicare Dependent Small Rural Hospital |
MED-ED |
Medical Education |
MEDB |
Medicare Part B |
MEDPAC |
Medicare Payment Advisory Commission |
MFCU |
Medicaid Fraud Control Unit |
MFS |
Medicare Fee Schedule |
MFSDB |
Medicare Fee Schedule Database |
MHB |
Maximum Hospital Benefit |
MIP |
Medicare Integrity Program |
MMCQI |
Medicare Managed Care Quality Improvement |
MN |
Medical Necessity |
MPD |
Medicare Provider Database |
MPDB |
Medicare Prescription Drug Beneficiaries |
MPFS |
Medicare Physician Fee Schedule |
MQA |
Medicare Quality Assurance (CWF data validation) |
MQAG |
Medicare Quality Advisory Group |
MQC |
Medicaid Quality Control |
MQM |
Medicare Quality Monitor |
MR/UR |
Medical Review / Utilization Review |
MRRS |
Medicaid Retrospective Reimbursement System |
MSHIP |
Medicare Supplemental Health Insurance Programs |
MTAG |
Medicare Technical Advisory Group |
MTOP |
Multiple Type of Provider |
NAATP |
National Association of Addiction Treatment Providers |
NACHC |
National Association of Community Health Centers |
NACHRI |
National Association of Children's Hospitals & Related Institutions |
NAHC |
National Association for Home Care |
NAHDO |
National Association of Health Data Organizations |
NAMES |
National Association of Medical Equipment Suppliers |
NAPH |
National Association of Public Hospitals |
NAPHS |
National Association of Psychiatric Health Systems |
NARA |
National Association of Rehabilitation Agencies |
NARF |
National Association of Rehabilitation Facilities |
NAS |
National Academy of Sciences |
NASMD |
National Association of State Medicaid Directors |
NCCLS |
National Council of Clinical Laboratory Services |
NCD |
National Coverage Determination |
NCHS |
National Center for Health Statistics |
NCQA |
National Committee for Quality Assurance |
NCQHC |
National Committee for Quality Health Care |
NDC |
National Drug Code |
NDPS |
National Drug Pricing System |
NH |
Nursing Home |
NHA |
Nursing Home Administrator |
NHB |
National Health Board |
NHO |
National Hospice Organization |
NIA |
National Institute on Aging |
NIAID |
National Institute of Allergies & Infectious Diseases |
NIAMSD |
National Institute of Arthritis & Musculoskeletal & Skin Diseases |
NIDA |
National Institute on Drug Abuse |
NIDDKD |
National Institute of Diabetes, Digestive & Kidney Diseases |
NIDR |
National Institute of Dental Research |
NIH |
National Institutes of Health |
NIMBE |
Not Including Medicare Benefits Exhausted |
NIMH |
National Institute of Mental Health |
NIMMS |
National Integrated Medicaid Management System |
NINDS |
National Institute of Neurological Disorders & Stroke |
NIOSH |
National Institute for Occupational Safety & Health |
NIST |
National Institute of Standards & Technology |
NLN |
National League of Nursing |
NMC |
National Maintenance Contractor |
NME |
National Medical Enterprises |
NMEP |
National Medicare Education Program |
NMFA |
National Medicare Fraud Alert |
NMFAI |
National Medicaid Fraud & Abuse Institute |
NMUD |
National Medicare Utilization Database |
NODMAR |
Notice of Discharge & Medicare Appeal Rights |
NOU |
Notice of Utilization |
NP |
Nurse Practitioner |
NP/PA |
Nurse Practitioners / Physician Assistants |
NPF |
National Provider File |
NPI |
National Provider Identifier |
NPRM |
National Provider Reimbursement Manual |
NRC |
National Research Council |
NTH |
NonTransplant Hospital |
NUBC |
National Uniform Billing Committee |
OAC |
OASIS Automation Coordinator |
OASIS |
Outcome & Assessment Information Set |
OBQI |
Outcome Based Quality Improvement |
OBQIM |
Outcome Based Quality Improvement Management |
OBQM |
Outcome Based Quality Monitoring |
OBRA |
Omnibus Budget Reconciliation Act |
OCE |
Outpatient Code Editor (System) |
OCESAA |
Omnibus Consolidated & Emergency Supplemental Appropriations Act for FY 1999 |
OCFAA |
Office of Civil Fraud & Administrative Adjudication |
OCR |
Office for Civil Rights |
ODL |
Outpatient Diagnostic Laboratory |
OEP |
Open Enrollment Period |
OFCCP |
Office of Federal Contract Compliance Programs |
OGE |
Office of Government Ethics |
OHCA |
Organized Health Care Arrangements |
OHRP |
Office for Human Research Protections |
OIG |
Office of the Inspector General |
OLTC |
Other Long Term Care |
OMIG |
Office of the Medicaid Inspector General |
OP |
Outpatient |
OP |
Overpayment |
OPAC |
Online Payment & Accounting Collection (System) (Treasury) |
OPD |
OutPatient Department |
OPDIV |
OPerating DIVision |
ORF |
Outpatient Rehabilitation Facility |
P&E |
Parenteral & Enteral |
P&T |
Pharmaceutical and Therapeutic |
P/B |
Provider / Beneficiary |
PARD |
Provider Audit & Reimbursement Department |
PARL |
Physician/Supplier Assignment Rate List |
PART A |
Medicare Hospital Insurance |
PART B |
Medicare Supplementary Medical Insurance |
PAYERID |
Payer Identification (national provider identifier initiative) |
PBC |
Premium Billing Code |
PBGC |
Pension Benefit Guaranty Corp. |
PBIS |
PerformanceBased Incentive System |
PBP |
Provider Based Physician |
PCH |
Primary Care Hospital |
PCP |
Primary Care Physician (or Provider) |
PCPR |
Provider Claims Processing Requirements |
PDMA |
Prescription Drug Marketing Act of 1988 |
PDP |
Prescription Drug Plan |
PEBTAG |
Provider Electronic Billing Technical Advisory Group |
PEPPER |
Program for Evaluating Payment Patterns Electronic Report |
PFCRA |
Program Fraud Civil Remedies Act |
PHI |
Protected Health Information |
PHRMA |
Pharmaceutical Manufacturers and Researchers of America |
PHY/SUP |
Physician/Supplier |
PIG |
Program Integrity Group, OFM, CMS |
PIM |
Medicare Program Integrity Manual |
PIPDCG |
Principal Inpatient Diagnostic Cost Group |
POC |
Plan of Care |
POL |
Physician Office Laboratories |
POMS |
Program Operations Manual System (SSA) (formerly Claims Manual CM)) |
POR |
Provider Overpayment Recovery |
POR |
Provider Overpayment Report |
PORS |
Provider Overpayment Recovery System |
PORS |
Provider Overpayment Reporting System |
POT |
Plan of Treatment |
PPACA |
Patient Protection & Affordable Care Act (also ACA) |
PPC |
Processing Payment Cycle |
PPG |
Primary Care Physician Groups |
PPS |
Prospective Payment System (Medicare Part A) |
PPSA |
Physician Payment Sunshine Act |
PQRS |
Physician Quality Reporting System |
PRM |
Provider Reimbursement Manual |
PRMDS |
Provider Minimum Data Set |
PRS |
Payment Reconciliation System |
PS&RR |
Provider Statistical & Reimbursement Report |
PSPRICE |
Physician Fee Schedule System |
PTA |
Part A (of Medicare) |
PTAMUS |
Part A Medicare Utilization System |
PTB |
Part B (of Medicare) |
QMB |
Qualified Medicare Beneficiaries |
RA |
Risk Assessment |
RAAC |
Risk Adjustment Advisory Committee |
RAC |
Reimbursement Advisory Committee |
RADV |
Risk Adjustment Data Validation |
RAPS |
Risk Adjustment Processing System |
RAPS |
Risk Adjustment Processing System |
RAS |
Risk Adjustment System |
RCL |
Routine Cost Limit |
RCP |
Reasonable Charge Pricing |
RCT |
Randomized Clinical Trials |
RH |
Rural Hospital |
RHC |
Rural Health Center |
RHC |
Rural Health Claim |
RHC |
Rural Health Clinic |
RHP |
Rebundling of Hospital Payment |
RMFA |
Restricted Medicare Fraud Alert |
ROAR |
Recovery of Overpayments Accounting & Reporting System (SSA) |
ROAR |
Regional Office Automating Representatives for Managed Care Operations (ROAR for MCO) |
RPCH |
Regional Primary Care Hospital |
RPCH |
Rural Primary Care Hospital |
RTP |
Return To Provider (or Plan) |
SA |
Settlement Agreement |
SMG |
State Medicaid Group |
SMM |
State Medicaid Manual |
SNC |
Skilled Nursing Care |
SNF |
Skilled Nursing Facility |
SOM |
State Operations Manual |
SRA |
Significant Regulatory Actions |
SSA |
Social Security Act |
SSA |
Social Security Administration |
SSA |
State Survey Agency |
SSH |
Short Stay Hospital |
T18 |
Title XVIII of the Social Security Act (Medicare) |
T19 |
Title XIX of the Social Security Act (MAA (Medicaid)) |
UPL |
Upper Payment Limit (Medicaid) |
UR |
Utilization Review |
URAC |
Utilization Review Accreditation Commission |
WHO |
World Health Organization |
WPA |
Whistleblower Protection Act |
Healthcare Compliance and CMS Acronyms
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