Skip to content

Useful 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™