Acronyms and Glossary

This acronym listing is intended to assist with common terminology but is not all-inclusive.

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Acronyms

Acronym Description
A Assigned (Claim)
AA Anesthesia Assistant
AAA Abdominal Aortic Aneurysm
ABN Advance Beneficiary Notice of Noncoverage
AC Action Code
AC Appeals Council
ACS Automated Correspondence System
ACT Ask the Contractor Teleconference
ADA American Dental Association
ADA American Diabetes Association
ADJ Adjustment
ADMC Advance Determination of Medicare Coverage
ADP Automated Data Processing
ADR Additional Development Request
ADS Automated Development System
AFO Ankle Foot Orthosis
AIC Amount in Controversy
ALJ Administrative Law Judge
ALS Advanced Life Support (ambulance)
AMA American Medical Association
ANSI American National Standards Institute
AOB Assignment of Benefits
APC Ambulatory Payment Classification
APG Ambulatory Patient Group
APR Automatic Password Reset
ASA American Society of Anesthesiologists
ASC Ambulatory Surgical/Surgery Center
ASCA Administrative Simplification Compliance Act
ASP Average Sale Price
ASP Average Sales Price
AWP Average Wholesale Price (drugs)
AWP Average Wholesale Price
AWV Annual Wellness Visit
AZMESA Arizona Medical Equipment Suppliers Association
BBA Balanced Budget Act (of 1997)
BBM Bone Mass Measurements
BBRA Balanced Budget Refinement Act (of 1999)
BCRC Benefits Coordination & Recovery Center
BE Beneficiary Eligibility
BENE Beneficiary
BI Benefit Integrity
Big Sky AMES Association of Home Medical Equipment Suppliers (Montana and Idaho)
BIPA ‘Medicare, Medicaid & SCHIP‘ Benefits Improvement & Protection Act of 2000
BISC Benefit Integrity Support Center
BLS Basic Life Support (ambulance)
BP Benefit Protection
BPO Bureau of Program Operations (CMS)
CAC Contractor Advisory Committee (Part B)
CAH Critical Access Hospital
CAMPS California Association of Medical Product Suppliers
CARC Claim Adjustment Reason Code
CB Consolidated Billing
CBA Competitive Bidding Area
CBIC Competitive Bidding Implementation Contractor
CC Condition Code
CCI Correct Coding Initiative
CCN Correspondence Control Number
CCN Claim Control Number
CDC Center for Disease Control
CDE Certified Diabetic Educators
CEDI Common Electronic Data Interchange
CELIP Claim Expansion and Line Item Pricing
CERT Comprehensive Error Rate Testing
CEU Continuing Education Unit
CF Conversion Factor
CFR Code of Federal Regulations
CGS CIGNA Government Services
CHAMPUS Civilian Health Medical Program of the Uniformed Services
CHC Comprehensive Health Center
CLCCP Comprehensive Limiting Charge Compliance Program
CLIA Clinical Laboratory Improvement Amendments
CMD Contractor Medical Director
CMG Case Mix Group
CMHC Community Mental Health Center
CMN Certificate of Medical Necessity
CMR Comprehensive Medical Review
CMS Centers for Medicare & Medicaid Services
CMS-1500 Health Insurance Claim Form
CNM Certified Nurse Midwife
CNS Clinical Nurse Specialist
CO Central Office (CMS, in Baltimore, MD)
CO Contractual Obligation (RA)
CO Contracting Officer
COA Change of Address
COB Close of Business
COB Coordination of Benefits
COB/COBC Coordination of Benefits or Coordination of Benefits Contractor
COBA Coordination of Benefits Agreement
COBC Coordination of Benefits Contractor
COBRA Consolidated Omnibus Budget Reconciliation Act of 1985
COINS Coinsurance
CORF Comprehensive Outpatient Rehabilitation Facility
COTS Commercial-Off-The-Shelf
CP Clinical Psychologist
CPAP Continuous Positive Airway Pressure
CPI Consumer Price Index
CPO Care Plan Oversight
CPT Current Procedural Terminology
CPT Claims Processing Timeliness
CR Change Request
CRD Chronic Renal Disease
CRNA Certified Registered Nurse Anesthetist
CSI Claim Status Inquiry
C-Status Contractor-determined allowance
CSW Clinical Social Worker
CWF Common Working File
CWF/MSP Common Working File/Medicare Secondary Payer
CY Calendar Year
DAB Departmental Appeals Board
DAC DME MAC Advisory Committee
DC Doctor of Chiropractic
DCN Document Control Number
DDE Direct Data Entry
DDS Doctor of Dental Surgery
DEDUCT Deductible
DEFRA Deficit Reduction Act
DHHS Department of Health and Human Services
DHS Designated Health Services
DIF DME Information Form
DMD Doctor of Medical Dentistry
DMD DME Medical Director
DME Durable Medical Equipment
DME MAC Durable Medical Equipment Medicare Administrative Contractor
DMECS Durable Medical Equipment Coding System
DMEPOS Durable Medical Equipment, Prosthetics, Orthotics and Supplies
DMEPOS Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
DMERC Durable Medical Equipment Regional Carrier
DO Doctor of Osteopathy
DOB Date of Birth
DOD Date of Discharge
DOD Date of Death
DOE Date of Entitlement
DOJ Department of Justice
DOR Date of Receipt
DOS Date of Service
DP Doctor of Podiatry
DPM Doctor of Podiatric Medicine
DRA Deficit Reduction Act
DSC Doctor of Surgical Chiropody
DSH Disproportionate Share
DSP Doctor of Surgical Podiatry
DX Diagnosis
E/M, E&M Evaluation and Management
ECG Electrocardiogram
ED Emergency Department
EDI Electronic Data Interchange
EDISS Electronic Data Interchange Support Services
EDS Electronic Data Systems Corp.
EFT Electronic Funds Transfer
EGHP Employer Group Health Plan
EHR Electronic Health Records
EI Economic Index
EIN Employer Identification Number
EKG Electrocardiogram
EMC Electronic Media Claim
EMT Emergency Medical Technician
EMTALA Emergency Medical Treatment & Active Labor Act
EOB Explanation of Benefits
EOMB Explanation of Medicare Benefits
ERA Electronic Remittance Advice
ERL Electronic Receipt Listing
ERN Electronic Remittance Notice
ERP Education Recognition Program
eRx Electronic Prescribing
ESRD End Stage Renal Disease
FAQ Frequently Asked Question
FBI Federal Bureau of Investigations
FCN Financial Control Number
FDA Food & Drug Administration
FDA Food and Drug Administration
FFP Federal Financial Participation
FFS Fee-for-Service
FH Fair Hearing
FI Fiscal Intermediary
FISS Fiscal Intermediary Standard Systems (Part A processing system)
FL Form Locator
FMR Focused Medical Review
FOIA Freedom of Information Act
FQHC Federally Qualified Health Center
FR Final Rule
FR Federal Register
FRC Federal Records Center
FY Fiscal Year
GAO Government Accountability Office
GBA Government Benefits Association
GEHA Government Employees Hospital Association
GHP Group Health Plan
GPCI Geographic Practice Cost Index
HAH Healthcare Association of Hawaii
HBP Hospital Based Physician
HCPCS Healthcare Common Procedure Coding System
HH Home Health
HHA Home Health Agency
HHS Department of Health & Human Services
HHS Health and Human Services
HIMR Health Insurance Master Record (Social Security)
HIPAA Health Insurance Portability and Accountability Act of 1996
HIPPS Health Insurance Prospective Payment System
HME Home Medical Equipment
HMO Health Maintenance Organization
HPSA Health Professional Shortage Area
HSIP HPSA Surgical Incentive Payment
IACS Individuals Authorized Access to CMS Computer Services
ICD-10 International Classification of Diseases, Tenth Revision
ICD-9 The International Classification of Diseases, Ninth Revision
ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification
ICN Internal Control Number
ICU Intensive Care Unit
IDE Investigational Device Exemption
IDPN Intradialytic Parenteral Nutrition
IDTF Independent Diagnostic Testing Facility
IG Implementation Guide (HIPAA)
IHS Indian Health Service
IIC Inflation Index Charge-Customary
IIC Inflation-Indexed Charge
IIP Inflation Index Charge-Prevailing
IL Independent Laboratory
IME Indirect Medical Education
Inpt Inpatient
IOL Intraocular lens
IOM Internet Only Manual
IP Independent Psychologist
IPL Independent Physiological Laboratory
IPPB Intermittent Positive Pressure Breathing
IPPE Initial Preventive Physical Examination (Welcome to Medicare)
IPPS Inpatient Prospective Payment System
IRF Inpatient Rehabilitation Facilities
IRP Inexpensive or other Routinely Purchased DME
IRS Internal Revenue Service
IV Intravenous
IVR Interactive Voice Response
IVR Interactive Voice Response (system)
KAFO Knee Ankle Foot Orthosis
LCD Local Coverage Determination (medical policy)
LCD Local Coverage Determination
LCER Limiting Charge Exception Report
LCL Lowest Charge Level
LFS Laboratory Fee Schedule
LGHP Large Group Health Plan
LIP Low Income Payment
LLP Limited License Practitioner
LOC Level of Care
LON Length of Need
LOS Length of Stay
LPN Licensed Practical Nurse
LSO Lumbar Sacral Orthosis
LTC Long Term Care
LTCF Long Term Care Facility
LTR Lifetime Reserve Days
LVN Licensed Vocational Nurse
MA Plan Medicare Advantage Plan (formerly Medicare+Choice or Medicare HMO)
MAC Medicare Administrative Contractor
MAE Mobility Assistive Equipment
MAMES Midwest Association for Medical Equipment Services
MA-PD Medicare Advantage Prescription Drug Plans
MBI Medicare Beneficiary ID
MCO Managed Care Organizations
MCPS Medicare Claims Processing System
MCPSS Medicare Contractor Provider Satisfaction Survey
MCS Multi Carrier System
MD Medical Doctor
MDS Minimum Data Set
MEDIGAP A Medicare complementary insurance program
MEDPARD Medicare Participating Physician/Supplier Directory
MEI Medicare Economic Index
MFAIC Medicare Fraud and Abuse Information Coordinator
MIA Medicare Inpatient Adjudication
MLN Medicare Learning Network
MM Medlearn Matters
MMA Medicare Modernization Act (of 1999)
MOA Medicare Outpatient Adjudication
MPFS Medicare Physician Fee Schedule
MPFSDB Medicare Physician Fee Schedule Data Base
MR Medical Review
MRADL Mobility Related Activity of Daily Living
MREP Medicare Remit Easy Print
MREP Medicare Remit Easy Print (software)
MRN Medicare Remittance Notice
MS Maintenance and Servicing
MSA (Medicare) Medical Savings Account
MSA Metropolitan Statistical Area
MSN Medicare Summary Notice (notice to beneficiaries)
MSO Management Service Organization
MSP Medicare Secondary Payer
MTS Medicare Transaction System
MUE Medically Unlikely Edit
MVPS Medicare Volume Performance Standard
NA Non-assigned (Claim)
NAMPS Nevada Association of Medical Products Suppliers
NCB National Competitive Bid
NCCI National Correct Coding Initiatives Edits
NCD National Coverage Determination
NCPDP National Council for Prescription Drug Program
NDAB National Diabetes Advisory Board
NDC National Drug Code
NH Nursing Home
NHCMQ Nursing Home Case-Mix and Quality Demonstration
NMW Nurse Midwife
NOBA Notice of Budget Authority
NOC Not Otherwise Classified
NON-PAR Non-participating Provider
NOOH Notice of an Opportunity for a Hearing
Noridian Noridian Healthcare Solutions
NOS Number of Service
NP Nurse Practitioner
NPI National Provider Identifier
NPP Non-physician Practitioner
NPPES National Plan and Provider Enumeration System
NPRM Notice of Public Rule Making
NPWT Negative Pressure Wound Therapy
NSC National Supplier Clearinghouse
NSF National Standard Format
NSF Non-sufficient Funds
NTIS National Technical Information Service
NUBC National Uniform Billing Committee
NUCC National Uniform Claim Committee
OA Other Adjustment
OAS Office of Audit Service of the Department of Health and Human Services
OBRA Omnibus Budget Reconciliation Act
OCC Occurrence Code
OCE Outpatient Code Editor
OCNA Other Carrier Name/Address
OCR Optical Character Recognition
OD Doctor of Optometry
OD Doctor of Optometry (Optometrist)
OD Onset Date
OI Office of Investigations
OIFO Office of Investigations Field Office
OIG Office of Inspector General
OIG Office of the Inspector General
OLC Online Learning Center
OMB Office of Management and Budget
OMCA Other Medicare Change Assessment
OMHA Office of Medicare Hearings and Appeals
OMRA Other Medicare Required Assessment
OPPS Outpatient Prospective Payment System
OPT Outpatient Physical Therapy
OSC Occurrence Span Code
OT Occupational Therapy
OTAF Obligated to Accept as Payment in Full
OTC Over the Counter Drug
OTPT Outpatient
PA Physician Assistant
PA Policy Article
PAMES Pacific Association for Medical Equipment Services (Oregon and Washington)
PAOC Program Advisory and Oversight Committee
PAR Participating Physician
PAYERID Payer Identification (Number)
PC Professional Component
PCA Progressive Corrective Action
PCC Provider Contact Center
PCIP Primary Care Incentive Payment Program
PCP Primary Care Physician (or Provider)
PDAC Pricing, Data Analysis and Coding
PDP Prescription Drug Plan
PDR Physician’s Desk Reference
PDT Purchased Diagnostic Test
PECOS Provider Enrollment, Chain & Ownership System
PECOS Provider Enrollment, Chain and Ownership System
PEN Parenteral and Enteral Nutrition
PFS Physician Fee Schedule
PHC Public Health Clinic
PHI Protected Health Information
PHP Partial Hospitalization Program
PHSA Public Health Service Act
PIM Program Integrity Manual
PIN Provider Identification Number
PM Program Memorandum
PMD Power Mobility Device
POA Present On Admission
POCI Provider Ownership Compensation Interest
POE Provider Outreach and Education
POE AG Provider Outreach and Education Advisory Group
POL Physicians Office Lab
POS Place of Service
POS Point of Service Option (for an HMO)
POV Power Operated Vehicle
PPO Preferred Provider Organization
PPR Physician Payment Reform
PPS Prospective Payment System
PPTN Professional Provider Telecommunications Network
PPV Pneumococcal Pneumonia Vaccine
PQRS Physician Quality Reporting System
PR Patient Responsibility
PRO Peer Review Organization
PROV Provider
PS&R Provider Statistical and Reimbursement Report
PSC Program Safeguard Contractor
PSO Provider Sponsored Organization
PSYCH Psychiatric Services
PT Patient
PT Physical Therapy
PTAN Provider Transaction Access Number (formerly PIN)
Q&A Questions and Answers
QAP Quality Assurance Program
QC Quality Control
QI Qualifying Individuals (Medicaid)
QIC Qualified Independent Contractor
QIO Quality Improvement Organization
QMB Qualified Medicare Beneficiary (Medicaid)
RA Remittance Advice
RAC Recovery Audit Contractor
RAD Respiratory Assistive Device
RAI Resident Assessment Instrument
RAP Resident Assessment Protocol
RARC Remittance Advice Remark Code
RBRVS Resource Based Relative Value Scale
RBRVU Resource Based Relative Value Unit
RC Reasonable Charge
RC Reason Code
REMIT Remittance Advice
REP PAYEE Representative Payee
RFB Religious Fraternal Benefit Society Plan
RHC Rural Health Clinic
RHHI Regional Home Health Intermediary
RIC Rehabilitation Impairment Categories
RN Registered Nurse
RO Regional Office (CMS)
RO Regional Office, CMS
RPCH Rural Primary Care Hospital (now Critical Access Hospital)
RPT Registered Physical Therapist
RRB Railroad Retirement Board
RT Respiratory Therapy
RUG Resource Utilization Groups
RVC Revenue Code
RVS Relative Value Scale
RVU Relative Value Unit
SACU Supplier Audit and Compliance Unit
SAD Self-Administered Drug
SADMERC Statistical Analysis DMERC
SB Swingbed
SBIRT Screening, Brief Intervention, and Referral to Treatment
SCHIP State Children’s Health Insurance Program
SCPFA Significant Correction of a Prior Full Assessment
SCSA Significant Changes in Status Assessment
SE Special Edition
SGS SafeGuard Services
SHIPs State Health Insurance Plan
SIIS Supplemental Insurance Interface System (crossover claim)
SLM Seat Lift Mechanism
SLMB Specified Lower Income Medicare Beneficiary (Medicaid)
SLP Speech Language Pathology
SMRC Supplemental Medical Review Contractor
SNC Skilled Nursing Care
SNF Skilled Nursing Facility
SOS Site of Service
SPAN Occurrence Span Code
SPR Standard Paper Remittance
SSA Social Security Administration
SSI Supplemental Security Income
SSN Social Security Number
SSNRI Social Security Number Removal Initiative
SWG Swingbed
TAN Treatment Authorization Number
TAT Turn-around-time
TC Technical Component
TCU Transitional Care Unit
TEFRA Tax Equity & Fiscal Responsibility Act of 1982 (PL97248)
TENS Transcutaneous Electrical Nerve Stimulation
TIN Taxpayer Identification Number
TLSO Thoracic-Lumbar-Sacral Orthosis
TMJ Temporomandibular Joint Dysfunction
TOB Type of Bill
TOP Transitional Outpatient Payment
TOS Type of Service
TPN Total Parenteral Nutrition
TTY Text Teletype
UIN Unique Identification Number (System Security)
UMWA United Mine Workers Association
UPIN Unique Provider Identification Number
UPIN Unique Physician Identification Number
UR Utilization Review
USP U.S. Pharmacopoeia
UTMED Utah Medical Equipment Dealers
VA Veterans Administration
VC Value Code
WAC Wholesale Acquisition Cost
WBT Web-based Training
WC Workers Compensation
WEDI Workgroup for Electronic Data Interchange
WHO World Health Organization
WIC Western Integrity Center
WPC Washington Publishing Company
YTD Year-to-Date
ZIP Zoning Improvement Plan (ZIP Codes)
ZPIC Zone Program Integrity Contracts
ZPIC Zone Program Integrity Contractor

 

Glossary

Term Description
Adjudicator The entity responsible for making the specific Medicare claim decision at any level from initial determination to final level of appeal.
Affirmation CMS and MAC contractor use this term when the same conclusion was reached as the prior determination.
Appellant The beneficiary, provider, supplier or representative that has filed an appeal. The adjudicator determines if the appellant is the proper party to the appeal.
Appointed representative The appointed individual to represent the party in the Medicare appeal or claim. By signing the appointment form, the representative indicates acceptance.
Assignee 1.) Assignment of claim for items or services is the supplier or provider of the service to the beneficiary and has accepted assignment of the claim.

2.) Assignment of appeal rights – is someone who does not meet the description of #1 and has accepted a valid assignments executed by the beneficiary.
Assignment of appeal rights The transfer by a beneficiary of his/her appeals rights. The assignment cannot be made to a provider or supplier that provided the services and accepts assignment of the claim.
Assignor The provider or supplier that has taken assignment of the claim or an appeal of a claim.
Authorized Representative The individual authorized by the State or other law to represent the beneficiary. The authorized representative has all the rights and responsibilities of beneficiary.
Beneficiary The individual enrolled and receives benefits under Medicare Part A and/or Part B.
Contractor Contracted with the Federal government to review and/or adjudicate claims, determinations and/or decisions.
Date of Receipt Presumed received five calendar days from the date on the determination or decision, unless there is evidence to the contrary.
Decision and Determinations There is no apparent particle distinction between the terms; it is the appeal results. It is not a dismissal. A decision that is reopened is called “revised determination.”
Dismissal The decision made by the adjudicator when an appeal will not be conducted as requested.
Effectuate The contractor to issue a payment.
Provider of Services Part A: A hospital, a critical access hospital (CAH), a skilled nursing facility (SNF), a comprehensive outpatient rehabilitation facility (CORF), a home health agency, or a hospice, a clinic, rehabilitation agency or public health agency that has an agreement to furnish outpatient physical therapy or speech pathology service, a community mental health center that furnishes partial hospitalization services.

Part B: Some services include but not limited to: Physician services (including podiatrists, chiropractors, optometrists), Ambulance services, Independent Clinical Laboratories, Independent Diagnostic Testing Facilities (IDTFs), Non-physician Practitioners (Nurse Practitioners (NPs), Physician Assistants (PAs), Certified Registered Nurse Anesthetists (CRNAs), Certified Nurse Midwives (CNM), Licensed Clinical Social Workers (LCSWs), Clinical Psychologists (CPs)
Remand Action taken by the adjudicator to vacate a lower level of appeal decision to that level for a new decision.
Reopening A remedial action taken to change a final determination or decision that resulted in either an overpayment or an underpayment, even though the determination or decision was correct based on the evidence of record. It is a separate and distinct from the appeals process used to revise an initial determination or redetermination.
Reversal Medicare uses this term when the new determination/decision is more favorable to the appellant than the prior/last determination/decision; even it some parts of the prior determination/decision remains the same. The term reversal describes the coverage determination, not the liability determination.
Revised Determination or Decision To reopen the initial determination or decision and issuing a revised determination or decision results. The first level of appeal following a revised initial determination is a redetermination.
Supplier A physician, or other practitioner, a facility or entity (other than a provider of services) that furnished services or items under Medicare.
Vacate To set aside the previous action.

 

Last Updated Nov 15, 2018