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Glossary of Terms

 

CODE: Definition – REVISION DATE 6.22.09

  • 278: Pretreatment Authorization & Referrals
  • 855: The group of federal forms used by Medicare Carriers to enroll providers and issue Provider Numbers. Sometimes referred to as credentialing.
  • 1490: Federal claim form
  • 1500: Federal claim form used to submit claims for physicians. Also referred to as the “CMS and formerly referred to as the "HCFA 1500" form.
  • 270 & 271: Electronic Eligibility Verification
  • 276 - 275 - 277: Claim Status Inquiries
  • 837 - 275: Claim Submission
  • A: Assigned (claim)
  • AARP: American Association of Retired Persons
  • ABN: Advance Beneficiary Notice
  • ADA: American Dental Association; or American Diabetes Association
  • AHIMA: American Health Information Management Association
  • ALJ: Administrative Law Judge
  • AMA: American Medical Association
  • ANSI: American National Standards Institute
  • APD: Audit Program Development
  • ARA: Associate Regional Administrator
  • ASA: American Society of Anesthesiologists
  • ASC: Ambulatory Surgical Center
  • AWP: Average Wholesale Price
  • BBA: Balanced Budget Act (of 1997)
  • BBRA: Balanced Budget Refinement Act (of 1999)
  • BIC: Beneficiary Identification Code (the suffix following the Social Security Number on a Medicare Card)
  • BL: Black Lung (Coal Miners)
  • BNA: Bureau of National Affairs
  • Bx: Biopsy (abbreviation)
  • CAC: Carrier Advisory Committee
  • CAH: Critical Access Hospital
  • CC: Chief complaint
  • CCI: Correct Coding Initiative
  • CCN: Correspondence Control Number
  • CDE: Certified Diabetic Educators
  • CERT: Comprehensive Error Rate Testing
  • CF: Conversion Factor
  • CFR: Code of Federal Regulations
  • CHAMP VA: Civilian Health and Medical Program of the Veterans Administration
  • CHAMPUS: Civilian Health and Medical Program of the Uniformed Services (now TriCare)
  • CHBMA: Certified Healthcare Billing & Management Associate
  • CIM: Coverage Issues Manual
  • CLIA: Clinical Laboratory Improvement Amendments (If you perform clinical lab tests in your office, you need a CLIA number)
  • CMBA: Certified Medical Billing Associate
  • CMD: Contractor Medical Director
  • CMHC: Community Mental Health Center
  • CMIP: Comprehensive Medicaid Integrity Plan
  • CMN: Certificate of Medical Necessity
  • CMP: Civil Monetary Penalty
  • CMPL: Civil Monetary Penalty Law
  • CMR: Comprehensive Medical Review
  • CMS: The Centers for Medicare St Medicaid Services (formerly known as HCFA, the Health Care Financing Administration)
  • CNM: Certified Nurse Midwife
  • CNMW: Certified Nurse Midwife
  • CNS: Certified Nurse Specialist
  • CO: Central Office (CMS, in Baltimore, MD)
  • COB: Coordination of Benefits
  • COBC: Coordination of Benefits Contractor
  • COBRA: Consolidation Omnibus Budget Reconciliation Act of 1986
  • CORF: Comprehensive Outpatient Rehabilitation Facility
  • CP: Clinical Psychologist
  • CPC: Certified Professional Coder
  • CPO: Care Plan Oversight
  • CPT: Current Procedural Terminology (5-digit codes, all numeric; Coding manual published yearly by the AMA)
  • CR: Change Request
  • CRD: Chronic Renal Disease
  • CRNA: Certified Registered Nurse Anesthetist
  • CSW: Clinical Social Worker
  • CWAG: Coalition of Wisconsin Aging Group
  • CWF: Common Working File (Medicare Part A and Part B claims history and entitlement information database)
  • DC: Doctor of Chiropractic
  • DDS: Doctor of Dental Surgery
  • DEFRA: Deficit Reduction Act of 1984
  • DHHS: Department of Health & Human Services
  • DHSQ: Division of Health Standards and Quality
  • DMD: Doctor of Medical Dentistry
  • DME: Durable Medical Equipment
  • DMEPOS: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
  • DMERC: Durable Medical Equipment Regional Carrier (Claims are processed by AdminaStar Federal, Inc.)
  • DO: Doctor of Osteopathy
  • DOB: Date of Birth
  • DOL: Department of Labor (Federal Agency)
  • DOS: Date of Service
  • DP: Doctor of Podiatry
  • DPM: Doctor of Podiatric Medicine
  • DRA: Deficit Reduction Act of 2006
  • DRG: Diagnostic Related Grouping
  • DSC: Doctor of Surgical Chiropody
  • DSP: Doctor of Surgical Podiatry
  • Dx: Diagnosis/Diagnoses (abbreviation)
  • E/M: Evaluation and Management (visit)
  • ECF: Extended Care Facility
  • EDT: Electronic Data Interchange
  • EEG: Electroencephalogram
  • EGHP: Employer Group Health Plan
  • EIN: Employer Identification Number (Tax ID/S SN)
  • EKG: Electrocardiogram
  • EMC: Electronic Media Claims
  • EMR: Electronic Medical Record
  • EOB: Explanation of Benefits
  • EPO: Epoetin Alfa
  • ERA: Electronic Remittance Advice
  • ERN: Electronic Remittance Notice
  • ESRD: End Stage Renal Disease
  • EVE: Electronic Funds Transfer
  • F&A: Fraud and Abuse
  • FCA: Full Claim Adjustment; or False Claim Act
  • FCN: Financial Control Number
  • FDA: Food and Drug Administration
  • FFS: Fee for Service
  • FO: Field Office
  • FOI: Freedom of Information
  • FOIA: Freedom of Information Act
  • FR: Federal Register
  • FT: Fiscal Intermediary
  • FTE: Full Time Equivalency; or Full Time Employee
  • FY: Fiscal Year
  • GAO: Government Accountability Office (formerly General Accounting Office)
  • GPCI: Geographic Practice Cost Index
  • HBP: Hospital Based Physician
  • HCFA: Health Care Financing Administration (now CMS)
  • HCPCS: Health Care Procedure Coding System (5-digit, alpha-numeric procedure code)
  • HDHP: High Deductible Health Plans
  • HER: Electronic Health Record
  • HHA: Home Health Agency
  • HHS: Health & Human Services (CMS is a branch of)
  • HI: Hospital Insurance
  • HIC: Health Insurance Claim (Number)
  • HIMR: Health Insurance Master Record
  • HIPAA: Health Insurance Portability and Accountability Act of 1996
  • HME: Home Medical Equipment
  • HMO: Health Maintenance Organization
  • HO: Hearing Officer
  • HPI: History of Present Illness
  • HPSA: Health Professional Shortage Area - also known by Health Manpower Shortage Area (HMSA)
  • HRSA: Health Resources Services Administration
  • I/P: Inpatient (Hospital)
  • ICD-10: The diagnosis coding system used in most countries outside of the US. This coding protocol has been planned for implementation for almost 10 years, but will not be implemented before 2012.
  • ICD-9-CM: Internal Classification of Diseases 9th Edition-Coding Manual (three-, four-, or five-digit codes based on specificity). The World Health Organization (WHO) holds the copyright to these codes.
  • ICN: Internal Control Number
  • ICU: Intensive Care Unit
  • IDTF: Independent Diagnostic Testing Facility
  • IIC: Inflation Index Charge-Customary
  • IL: Independent Laboratory
  • IOM: (National) Institute of Medicine
  • IOM: Internet-Only Manual
  • IP: Independent Psychologist
  • IPA: Independent Practice (or Physician) Association
  • IPIA: Improper Payment Improvement Act of 2002
  • IPL: Independent Psychological Laboratory
  • IRP: Incentive Rewards Program
  • IVR: Integrated Voice Response System
  • LCD: Local Coverage Decision (see LMRP, below)
  • LCER: Limiting Charge Exception Report
  • LFS: Laboratory Fee Schedule
  • lIP: Inflation Index Charge-Prevailing
  • LLP: Limited License Practitioner
  • LMFT: Licensed Marriage & Family Therapist
  • LMRP: Local Medical Review Policy
  • LPC: Licensed Professional Counselor
  • LVP: Licensed Vocational Nurse
  • MCD: Medicare Coverage Database
  • MCM: Medicare Carriers Manual
  • MCS: Multi Carrier System (processing system for Medicare Part B)
  • MD: Medical Doctor
  • MDM: Medical Decision Making
  • MEDPARD: Medicare Participating Physician/Supplier Directory
  • MET: Medicare Economic Index
  • MFCUs: State Medical Fraud Control Units
  • MFT: Marriage & Family Therapist
  • MICs: Medicaid Integrity Contractors
  • MIM: Medicare Intermediary Manual (Part A)
  • MIP: Medicaid Integrity Program
  • MMA: Medicare Modernization Act
  • MPFSDB: Medicare Physician Fee Schedule Database
  • MR: Medical Review
  • MR/UR: Medical Review/Utilization Review
  • MSN: Medicare Summary Notice
  • MSO: Management Service Organization
  • MSP: Medicare Secondary Payer
  • MSRR: Multiple Surgery Reduction Rule
  • NA: Non-assigned (claim)
  • NAIC: National Association of Insurance Commissioners
  • NCD: National Coverage Decision
  • NCP: National Coverage Provision
  • NDAB: National Diabetes Advisory Board
  • NDC: National Drug Code
  • NETT: National Emphysema Treatment Trials
  • NH: Nursing Home
  • NMW: Nurse Midwife
  • NOC: Not Otherwise Classified Code (Anytime you use an NOC code on your Medicare claim, you must provide a detailed description of the service provided)
  • NON-PAR: Non-Participating Provider
  • NOS: Not otherwise specified (as in the ICD-9 book)
  • NOS: Number of Service(s)
  • NP: Nurse Practitioner
  • NPI: National Provider Identifier (Will eventually replace all current Medicare provider numbers and UPINS)
  • NPP: Non-Physician Practitioner
  • NPRM: Notices of Proposed Rule Making
  • NSC: National Supplier Clearinghouse
  • NSF: National Standard Format
  • O/P: Outpatient
  • O/P: Overpayment
  • OAS: Office of Audit Services
  • OBRA: Omnibus Budget Reconciliation Act
  • OCFAA: Office of Civil Fraud and Administration Adjudication
  • OCR: Optical Claim Recognition
  • OD: Doctor of Optometry
  • OI: Office of Investigations
  • OIFO: Office of Investigations Field Office
  • OIG: Office of Inspector General — (of the Department of Health and Human Services [HHS])
  • OMB: Office of Management and Budget (botton of ABN forms)
  • ONCHIT: Office of the National Coordinator of Health Information Technology
  • OPPS: Outpatient Prospective Payment System
  • ORF: Outpatient Rehabilitation Facilities
  • OSCAR: Online Survey, Certification and Reporting (OSCAR System)
  • OT: Occupational Therapist
  • OTR: Outpatient Treatment Request
  • OV: Office Visit
  • PA: Physician Assistant
  • PAM: Payment Accuracy Measurement
  • PAR: Participating (physician)
  • PAYEE: Representative Payee
  • PAYER-ID: Payer Identification (Number)
  • PC: Professional Component
  • PCA: Progressive Corrective Action
  • PCOM: Provider Communication Advisory Group
  • PDT: Purchased Diagnostic Test
  • PECOS: Provider Enrollment Chain and Ownership System
  • PERM: Payment Error Rate Measurement program
  • PET: Provider Education and Training
  • PFSH: Past Family Social History
  • PHC: Public Health Clinic
  • PHSA: Public Health Service Act
  • PI: Program Integrity
  • PIM: Program Integrity Manual
  • PIMR: Program Integrity Management Reporting System
  • PIN: Physician Identifier Number
  • PM: Program Memorandum
  • POS: Place of Service or Point of Service Option (for an LIMO)
  • PP: Presenting Problem
  • PPO: Preferred Provider Organization
  • PPR: Physician Payment Reform
  • PPS: Prospective Payment System
  • PPV: Pneumococcal Pneumonia Vaccine
  • PRN: Provider Remittance Notice
  • PRO: Peer Review Organization
  • PSC: Program Safeguard Contractor
  • PT: Physical Therapy; Physical Therapist; or Patient
  • PTAN: Provider Transaction Access Number
  • QA: Quality Assurance
  • QIO: Quality Improvement Organization
  • RA: Remittance Advice
  • RBRVU: Resource Based Relative Value Unit
  • RC: Reasonable Charge
  • RCM: Revenue Cycle Management
  • RHC: Rural Health Clinic
  • RHHI: Regional Home Health Intermediary
  • RHIA: Registered Health Information Administrator (previously RRA)
  • RHIO: Regional Health Information Organization
  • RN: Registered Nurse
  • RO: Regional Office (CMS)
  • ROS: Review of Systems
  • RPT: Registered Physical Therapist
  • RRB: Railroad Retirement Board
  • RVS: Relative Value Unit
  • RVU: Relative Value Unit
  • RX: Prescription
  • SDP: Single Drug Pricer
  • SHIP: Senior Health Insurance Program; or State Health Insurance Assistance Program
  • SMERF: State Medicaid Error Rate Findings
  • SMI: Supplemental Medical Insurance
  • SNAP: Secure Net Access Pilot
  • SNF: Skilled Nursing Facility
  • SOS: Site of Service
  • SPEC: (Provider) Specialty
  • SPIA: State Program Integrity Assessment
  • SPR: Standard Paper Remittance
  • SSA: Social Security Administration
  • SSI: Supplemental Security Income
  • SSN: Social Security Number
  • Superbill: Form used by office-based practices to record and report CPT-4 and/or ICD-9 CM codes. Also known as "The Encounter Form" or 'Router" (Michigan Only)
  • TAN: Treatment Authorization Number
  • TC: Technical Component
  • TEFRA: Tax Equity and Fiscal Responsibility Act (of 1983)
  • TIN: Taxpayer Identification Number
  • TMJ: Temporomandibular Joint Dysfunction
  • TOS: Type of Service
  • TRF: Treatment Request Form
  • Tx: Treatment (abbreviation)
  • UB-04: The new version of the UB-92 form, scheduled for implementation in Q1/2007 ADA American Dental Association’s claim form
  • UB-92: Federal claim form used to submit claims for hospitals, rural health centers and other facility-based services
  • UCR: Usual, Customary and Reasonable
  • UPIN: Unique Physician Identification Number
  • UR: Utilization Review
  • USC: United States Code
  • VA: Veterans Administration
  • WC: Worker's Compensation
  • YTD: Year-to-Date

 

For a complete listing of the CMS acronyms, please visit: Center for Medicare & Medicaid Services

 

 

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