ABN |
Advance Beneficiary Notice |
ADJ |
Adjusted Claim |
ADR |
Additional Documentation Request |
ALJ |
Administrative Law Judge |
ALS |
Advanced Life Support (ambulance) |
ANSI |
American National Standards Institute |
APMs |
Alternative Payment Models |
ASC |
Ambulatory Surgical/Surgery Center |
ASCA |
Administrative Simplification Compliance Act |
ASP |
Average Sale Price |
AWP |
Average Wholesale Price (drugs) |
BBA |
Balanced Budget Act |
BETOS |
Berenson Eggers Type of Service |
BIPA |
"Medicare, Medicaid & SCHIP" Benefits Improvement & Protection Act of 2000 |
BLS |
Basic Life Support (ambulance) |
CAC |
Contractor Advisory Committee |
CAH |
Critical Access Hospital |
CARC |
Claim Adjustment Reason Code |
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 |
Center for Disease Control |
CERT |
Comprehensive Error Rate Testing program |
CFR |
Code of Federal Regulations |
CHC |
Comprehensive Health Center |
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 |
CNS |
Clinical Nurse Specialist |
COA |
Change of Address |
COB |
Close of Business |
COB |
Coordination of Benefits |
COBC |
Coordination of Benefits Contractor |
COB&R |
Coordination of Benefits & Recovery |
COBRA |
Consolidated Omnibus Budget Reconciliation Act of 1985 |
CORF |
Comprehensive Outpatient Rehabilitation Facility |
CPIL |
Claims Payment/Processing Issues Log |
CPO |
Care Plan Oversight |
CPT-4 |
Current Procedural Terminology |
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 |
DAB |
Departmental Appeals Board (ALJ) |
DCN |
Document Control Number |
DHHS |
Department of Health and Human Services |
DMAC |
DME Medicare Administrative Contractor |
DME |
Durable Medical Equipment |
DMEPOS |
Durable Medical Equipment, Prosthetics, Orthotics and Supplies |
DOE |
Date of Entitlement |
DOD |
Date of Death |
DOJ |
Department of Justice |
DOS |
Date of Service |
DX |
Diagnosis |
ED |
Emergency Department |
EDI |
Electronic Data Interchange |
EFT |
Electronic Funds Transfer |
EGHP |
Employer Group Health Plan |
EIN |
Employer Identification Number |
E/M |
Evaluation and Management |
EMT |
Emergency Medical Technician |
EMTALA |
Emergency Medical Treatment & Active Labor Act |
EOB |
Explanation of Benefits |
ERA |
Electronic Remittance Advice |
ERN |
Electronic Remittance Notice |
ESRD |
End Stage Renal Disease |
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/CY |
Fiscal Year/Calendar Year |
HCPCS |
Health Care Procedure Coding System |
HHA |
Home Health Agency |
HHH |
Home Health and Hospice |
HHS |
Department of Health and Human Services |
HIC |
Health Insurance Claim |
HICN |
Health Insurance Claim Number (Medicare Number) |
HIMR |
Health Insurance Master Record (Social Security) |
HIPAA |
Health Insurance Portability and Accountability Act of 1996 |
HMO |
Health Maintenance Organization |
HPSA |
Health Professional (or Personnel) Shortage Area |
ICD-9-CM |
International Classification of Diseases, 9th Revision, Clinical Modification |
ICD-10-CM |
International Classification of Diseases, 10th Revision, Clinical Modification |
ICN |
Internal Control Number |
IDE |
Investigational Device Exemption |
IDTFs |
Independent Diagnostic Testing Facilities |
IG |
Implementation Guide (HIPAA)
|
IPPS |
Implementation Guide (HIPAA)
Inpatient Prospective Payment System |
IRF |
Inpatient Rehabilitation Facility |
IVR |
Interactive Voice Response |
JJ |
Jurisdiction J Part A and Part B providers in Alabama, Georgia and Tennessee |
JM |
Jurisdiction M Part A and Part B providers in North Carolina, South Carolina, Virginia and West Virginia |
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 |
MA-PD |
Medicare Advantage Prescription Drug Plans |
MACRA |
Medicare Access and CHIP Reauthorization Act of 2015 |
MA Plan |
Medicare Advantage Plan (formerly Medicare+Choice or Medicare HMO) |
MAC |
Medicare Administrative Contractor |
MBI |
Medicare Beneficiary Identifier |
MCD |
Medicare Coverage Database |
MCO |
Managed Care Organizations |
MCS |
Multicarrier System |
MEDIGAP |
A Medicare complementary insurance program |
MEDPARD |
Medicare Participating Physician and Supplier Director |
MEI |
Medicare Economic Index |
MFS |
Medicare Fee Schedule |
MIPS |
Merit-based Incentive Payment System |
MN |
Medical Necessity |
MPFSDB |
Medicare Physician Fee Schedule Data Base |
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 |
NSC |
National Supplier Clearinghouse |
NTIOLs |
New Technology Intraocular Lenses |
NIBC |
National Uniform Billing Committee |
NUCC |
National Uniform Claim Committee |
OBRA |
Omnibus Budget Reconciliation Act |
OCE |
Outpatient Code Editor (system) |
OIG |
Office of Inspector General |
OPPS |
Outpatient Prospective Payment System |
OTAF |
Obligated to Accept as Payment in Full |
OTC |
Over the Counter Drug |
PA |
Physician Assistant |
PA |
Prior Authorization |
PC |
Professional Component |
PCC |
Provider Contact Center |
PCP |
Primary Care Physician (or Provider) |
PCR |
Pre-Claim Review |
PDP |
Prescription Drug Plan |
PDR |
Physician's Desk Reference |
PECOS |
Provider Enrollment, Chain and Ownership System |
PFS |
Physician Fee Schedule |
PHI |
Protected Health Information (see also: HIPAA) |
PIN |
Provider Identification Number (see also: PTAN) |
POC |
Plan of Care |
POS |
Place of Service |
PPO |
Preferred Provider Organization |
PPS |
Prospective Payment System |
PQRI |
Physician Quality Reporting Initiative |
PR |
Patient Responsibility |
PSC |
Program Safeguard Contractor |
PTAN |
Provider Transaction Access Number (formerly PIN) |
QIC |
Qualified Independent Contractor |
QIO |
Quality Improvement Organization |
QMB |
Qualified Medicare Beneficiary (Medicare/Medicaid) |
QPP |
Quality Payment Program |
RA |
Remittance Advice |
RAC |
Recovery Audit Contractor |
RARC |
Remittance Advice Remark Code |
RBRVS |
Resource Based Relative Value Scale |
RHC |
Rural Health Clinic |
RHHI |
Regional Home Health Intermediary |
RO |
Regional Office (CMS) |
RRB |
Railroad Retirement Board |
RRB SMAC |
Railroad Retirement Board Specialty Medicare Administrative Contractor |
RT |
Respiratory Therapy |
RVS |
Relative Value Scale (or schedule) |
RVU |
Relative Value Unit |
SAD |
Self Administered Drug |
SCHIP |
State Children's Health Insurance Program |
SHIPs |
State Health Insurance Assistance Programs |
SMAC |
Specialty Medicare Administrative Contractor |
SNC |
Skilled Nursing Care |
SNF |
Skilled Nursing Facilities |
SSA |
Social Security Administration |
SSI |
Supplemental Security Income |
SSN |
Social Security Number |
TC |
Technical Component |
TEFRA |
Tax Equity and Fiscal Responsibility Act of 1982 (PL97248) |
TENS |
Transcutaneous Electrical Nerve Stimulation |
TIN |
Tax Identification Number |
TOS |
Type of Service |
TPE |
Targeted Probe and Educate |
TTY |
Text Telephones |
UPIN |
Unique Provider Identification Number |
USP |
U.S. Pharmacopoeia |
WA |
Working Aged |
WBT |
Web-Based Training |
WC |
Workers' Compensation |
WEDI |
Workgroup for Electronic Data Interchange |
WHO |
World Health Organization |
ZIP |
Zoning Improvement Plan (ZIP Codes) |