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Assigned Claims Claims from Part B provider, accepted as payment in full
AAPCC Adjusted Average Per Capita Cost
AAR Approval, Adjustment or Reject Response
ACR Adjusted Community Rate
ACRP Adjusted Community Rate Proposal
ADG-HOSDOM Ambulatory Diagnostic Group-Hospital Dominant (type of comprehensive risk adjustment model)
AHIMA American Health Information Management Association
ANSI American National Standards Institute
ANSI X12 837 Variable length file format for electronic submission of claim data (developed by the American National Standards Institute's Health Data Committee X12)
APC Ambulatory Payment Class (payment type under outpatient PPS)
BBA Balanced Budget Act (1997)
BBRA Balanced Budget Refinement Act (1999)
CPT-4 Current Procedural Terminology, 4th edition (for coding physician services and procedures)
CSSC Customer Service and Support Center
Carrier Company through whom Medicare Part B Claims are submitted to HCFA
CCI Correct Coding Initiative (type of edit to detect unbundling of claims or claims that should not appear together)
CD-RISC Clinically Detailed Risk Information System for Costs (type of comprehensive risk adjustment model)
CHPP Center for Health Plans and Providers
CLIA Clinical Laboratory Improvement Amendments
CMS Centers for Medicare and Medicaid Services (formerly HCFA)
COB Coordination of Benefits
CORF Comprehensive Outpatient Rehabilitation Facility
CR Change Request
CWFM CWF Maintenance Contractor
CWF Common Working File (National file of Medicare claims)
CPO Care Plan Oversight (category of claims for home health services)
DMERC Durable Medical Equipment Regional Carrier
DxGroup Diagnosis Group
DX Diagnosis
DRG Diagnosis Related Group
DNC Data Network Contractor
DMEPOS Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
DCN Document Control Number (See also ICN - Internal Control Number)
DCG Diagnostic Cost Group
DOS Date of Service
EDI Electronic Data Interchange
ERA Electronic Remittance Advice
EOMB Explanation of Medicare Benefits
ESRD End Stage Renal Disease
EIN Employer Identification Number
EDB Enrollment Database
EMC Electronic Media Claim
FFS Fee-for-Service
FI Fiscal Intermediary
FISS Fiscal Intermediary Standard System
FTP File Transfer Protocol
GROUCH GHP Report Output User Communication Help
HIPAA Health Insurance Portability and Accountability Act
HEDIS Health Employer Data and Information Set (A standard measure of quality of care)
HCFA 1450 Medicare Part A claim filing form/form used for Inpatient AND Outpatient Encounter Coding (Also called UB-92)
HPSA Health Professional Shortage
HCFA Health Care Financing Administration (now called CMS)
HPMS Health Plan Management System
H number Identification number (contract number) for Medicare+Choice Organizations
HHA Home Health Agency
HICN Health Insurance Claim Number
HDC HCFA Data Center
HCPCS HCFA Common Procedure Coding System (Uses three levels of codes: CPT-4, alphanumeric, and local codes)
HCIS HCFA Customer Information System
HCFA 1500 Medicare Part B claim filing form/form used for Physician Encounter Coding
HCC Hierarchical Coexisting Condition (type of comprehensive risk adjustment model)
Intermediary Company through whom Medicare Part A Claims are sent to HCFA
IP Internet Protocol
INFOMAN CWF Information Management System
IGS IBM Global Service
ICN Internal Code Number (See also DCN - Document Control Number)
ICD-9-CM International Classification of Diseases - 9th Edition - Clinical Modification (for coding diagnoses)
JCL Job Control Language
LMRPS Local Medical Review Policies
MBR Master Beneficiary Record
MDS Minimum Data Set
MSN Medicare Summary Notice
MSP Medicare Secondary Payer
MPFSDB Medicare Physician Fee Schedule Database
MedPAC Medical Payment Advisory Commission
MED Medicare Exclusion Database
MDCN Medicare Data Communications Network
MDC Major Diagnostic Category
MCS Multi Carrier System (Medicare Part B standard claims processing system)
MCO Managed Care Organization
MCCOY Managed Care Option Information System (Used to view beneficiary information)
M+CO Medicare + Choice Organization
MR Medical Review
M+C Medicare + Choice
M+C NSF Medicare + Choice National Standard Format
NPI National Provider Identifier
NOC Not Otherwise Classified
NSF National Standard Format
NCH National Claims History
NDM Network Data Mover
OCE Outpatient Code Editor
OIG Office of the Inspector General [HHS]
OMB Office of Management and Budget
OPL Operational Policy Letter
OSCAR Online Survey and Certification Reporting System
PFFS Private Fee-for-Service Plan
PRO Professional Review Organization; Peer Review Organization
PPS Prospective Payment System
POS Place of Service or Point of Service
Physician For encounter processing, any eligible individual who provides clinical services (including nonphysician practitioners and other suppliers)
PACE Program of All-Inclusive Care for the Elderly
Palmetto GBA Palmetto Government Benefits Administrators
PIP-DCG Principal Inpatient Diagnostic Cost Group
QISMC Quality Improvement System for Managed Care
RA Remittance Advice
RO Regional Office
RTP Return to Provider/Plan
SNF Skilled Nursing Facility
SMI Supplementary Medical Insurance (Part B)
TOS Type of Service
TPA Third Party Administrator
TCP/IP Transmission Control Protocol/Internet Protocol
UB-92 HCFA Medicare Part A Form/Form used for Hospital Inpatient AND Outpatient Encounter Data filing. (Also called HCFA 1450 Form)
UPIN Unique Physician Identification Number
UR Utilization Review
 
 
   
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