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Links & Acronyms

  • ABN – Advance Beneficiary Notice

  • ACO – Accountable Care Organization

  • ADJ – Adjusted Claim

  • ADL – Activities of Daily Living

  • ADR – Additional Documentation Request

  • ADRD – Alzheimer's Disease and Related Disorders

  • AHIMA – American Health Information Management Association

  • ALF – Assisted Living Facility

  • ALJ – Administrative Law Judge

  • ALS – Advanced Life Support (Ambulance)

  • APM – Alternative Payment Model

  • ASC – Ambulatory Surgical/surgery Center

  • BBA – Balanced Budget Act

  • BLS – Basic Life Support (Ambulance)

  • CAH – Critical Access Hospital

  • CARC – Claim Adjustment Reason Code

  • CASPER – Certification and Survey Provider Enhanced Program

  • CB – Consolidated Billing

  • CBIC – Competitive Bidding Implementation Contractor

  • CBR – Comparative Billing Report

  • CBT – Computer Based Training

  • CCI – Correct Coding Initiative

  • CCN – Claim Control Number

  • CDC – Centers for Disease Control and Prevention

  • CERT – Comprehensive Error Rate Testing Program

  • CFR – Code of Federal Regulations

  • CHAP – Community Health Accreditation Partner

  • CHIP – Children's Health Insurance Program

  • CLIA – Clinical Laboratory Improvement Act

  • CMHC – Community Mental Health Center

  • CMN – Certificate of Medical Necessity

  • CMR – Comprehensive Medical Review

  • CMS – Centers for Medicare & Medicaid Services

  • CNA – Certified Nursing Assistant

  • CNS – Clinical Nurse Specialist

  • COBRA – Consolidated Omnibus Budget Reconciliation Act of 1985

  • CORF – Comprehensive Outpatient Rehabilitation Facility

  • COTA – Certified Occupational Therapy Assistant

  • CPAP – Continuous Positive Airway Pressure

  • CPIL – Claims Payment/processing Issues Log

  • CPO – Care Plan Oversight

  • CR – Change Request

  • CRNA – Certified Registered Nurse Anesthetist

  • CSW – Clinical Social Worker

  • CWF – Common Working File

  • CWF/MSP – Common Working File/Medicare Secondary Payer

  • CY – Calendar Year

  • DC – Discharge

  • DCN – Document Control Number

  • DME – Durable Medical Equipment

  • DMEPOS – Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

  • DOD – Date of Death

  • DOE – Date of Entitlement

  • DOJ – Department of Justice

  • DOS – Date of Service

  • DX – Diagnosis

  • E/M – Evaluation & Management

  • ED – Emergency Department

  • EDI – Electronic Data Interchange

  • EFT – Electronic Funds Transfer

  • EGHP – Employer Group Health Plan

  • EIN – Employer Identification Number

  • EMT – Emergency Medical Technician

  • EOB – Explanation of Benefits

  • ERA – Electronic Remittance Advice

  • ERN – Electronic Remittance Notice

  • ESRD – End-Stage Renal Disease

  • F/U – Follow Up

  • FAQ – Frequently Asked Question

  • FDA – Food and Drug Administration

  • FFS – Fee-for-Service

  • FI – Fiscal Intermediary

  • FISS – Fiscal Intermediary Shared (or Standard) System

  • FOIA – Freedom of Information Act

  • FQHC – Federally-Qualified Health Center

  • FR – Federal Register

  • FY – Fiscal Year

  • HCPCS – Health Care Procedure Coding System

  • HHA – Home Health Agency

  • HHAide – Home Health Aide

  • HHH – Home Health and Hospice

  • HHPPS – Home Health Prospective Payment System

  • HHQI – Home Health Quality Initiative

  • HHRG – Home Health Resource Group

  • HHS – Department of Health & Human Services

  • HHVBP – Home Health Value-based Purchasing Model

  • HIC – Health Insurance Claim

  • HICN – Health Insurance Claim Number (Medicare Number)

  • HIPAA – Health Insurance Portability and Accountability Act

  • HMO – Health Maintenance Organization

  • HPSA – Health Professional (or Personnel) Shortage Area

  • IADL – Instrumental Activities of Daily Living

  • ICD-10-CM – International Classification of Diseases, 10th Revision, Clinical Modification

  • ICD-9-CM – International Classification of Diseases, 9th Revision, Clinical Modification

  • ICF/IID – Intermediate Care Facilities for Individuals with Intellectual Disabilities

  • ICN – Internal Control Number

  • IG – Inspector General

  • IPPS – Implementation Guide (See: HIPAA)

  • IRF – Inpatient Rehabilitation Facility

  • IVR – Interactive Voice Response

  • JCAHO – Joint Commission on Accreditation of Healthcare Organizations

  • JM HHH – Jurisdiction M Home Health and Hospice Providers in Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas

  • LCD - Local Coverage Determination (Medical Policy)

  • LOC - Level of Care

  • LTC - Long Term Care

  • LTCF - Long Term Care Facility

  • LUPA - Low Utilization Payment Adjustment

  • MA - Medicare Advantage

  • MAC - Medicare Administrative Contractor

  • MACPAC - Medicaid and CHIP Payment and Access Commission

  • MACRA - Medicare Access and CHIP Reauthorization Act of 2015

  • MBI - Medicare Beneficiary Identifier

  • MCD - Medicare Coverage Database

  • MCO - Managed Care Organization

  • Medigap - A Medicare Complementary/Supplemental Insurance Program

  • MedPAC - Medicare Payment Advisory Commission

  • MFS - Medicare Fee Schedule

  • MIPS - Merit-Based Incentive Payment System

  • MN - Medical Necessity

  • MR - Medical Review

  • MSN - Medicare Summary Notice (Notice to Beneficiaries)

  • MSP - Medicare Secondary Payer

  • MUA - Medically Underserved Area

  • MUE - Medically Unlikely Edit

  • NCD - National Coverage Determination

  • NDC - National Drug Code

  • NOC - Not Otherwise Classified

  • NP - Nurse Practitioner

  • NPI - National Provider Identifier

  • NPP - Non-Physician Practitioner

  • NPPES - National Plan and Provider Enumeration System

  • OAC - Oasis Automation Coordinator

  • OASIS - Outcome and Assessment Information Set

  • OBQI - Outcome-Based Quality Improvement

  • OBQM - Outcome-Based Quality Monitoring

  • OCE - Outpatient Code Editor (System)

  • OEC - OASIS Educational Coordinators

  • OIG - Office of the Inspector General

  • OT - Occupational Therapy/Therapist

  • OTAF - Obligated to Accept as Payment in Full

  • OTC - Over-the-Counter Drug

  • PA - Physician Assistant

  • PA - Prior Authorization

  • PCC - Provider Contact Center

  • PCP - Primary Care Physician (or Provider)

  • PCR - Pre-Claim Review

  • PDGM - Patient-Driven Groupings Model

  • PDP - Prescription Drug Plan

  • PDR - Physician's Desk Reference

  • PECOS - Provider Enrollment, Chain & Ownership System

  • PEP - Partial Payment Episode

  • PEPPER - Program for Evaluating Payment Patterns Electronic Report

  • PFS - Physician Fee Schedule

  • PHE - Public Health Emergency

  • PHI - Protected Health Information (See also: HIPAA)

  • PIN - Provider Identification Number (See also: PTAN)

  • POC - Plan of Care

  • POS - Place of Service

  • PPE - Personal Protective Equipment

  • PPO - Preferred Provider Organization

  • PPS - Prospective Payment System

  • PQRI - Physician Quality Reporting Initiative

  • PR - Patient Responsibility

  • PSC - Program Safeguard Contractor

  • PT - Physical Therapy

  • PTA - Physical Therapy Assistant

  • PTAN - Provider Transaction Access Number (Formerly PIN)

  • QIC - Qualified Independent Contractor

  • QIES - Quality Improvement Evaluation System

  • QIO - Quality Improvement Organization

  • QMB - Qualified Medicare Beneficiary (Medicare/Medicaid)

  • QPP - Quality Payment Program

  • RA - Remittance Advice

  • RAC - Recovery Audit Contractor

  • RAP - Request for Anticipated Payment

  • RARC - Remittance Advice Remark Code

  • RBRVS - Resource-Based Relative Value Scale

  • RCD - Review Choice Demonstration

  • RFA - Reason for Assessment

  • RHC - Rural Health Clinic

  • RHHI - Regional Home Health Intermediary

  • RO - Regional Office (See also: CMS)

  • ROC - Resumption of Care

  • RRB - Railroad Retirement Board

  • RT - Respiratory Therapy/Therapist

  • RVS - Relative Value Scale (or Schedule)

  • RVU - Relative Value Unit

  • S&C - Survey and Certification

  • SA - State Agency

  • SCIC - Significant Change in Condition

  • SLP - Speech-Language Pathology

  • SMMC - Statewide Medicaid Managed Care

  • SN - Skilled Nursing

  • SNF - Skilled Nursing Facility

  • SOB - Shortness of Breath

  • SOC - Start of Care

  • SSA - Social Security Administration

  • SSI - Supplemental Security Income

  • SSN - Social Security Number

  • ST - Speech Therapy/Therapist

  • TIN - Tax Identification Number

  • TOS - Type of Service

  • TPE - Targeted Probe and Educate

  • TTY - Text Telephones

  • UPIN - Unique Provider Identification Number

  • UTN - Unique Tracking Number

  • WC - Workers' Compensation

  • WHO - World Health Organization

  • WOCN - Wound, Ostomy, and Continence Nurses Society™

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