|
A08 |
HL7 Update Patient Registration
Message |
| A/B MAC |
Medicare Administrative Contractor
(Replacement for Medicare FI/Carrier System) |
|
AAA |
Abdominal Aortic Aneurysm
|
| AAHAM |
American Association of Healthcare
Administrative Management |
| ABN |
Advance Beneficiary Notice of Non
Coverage (ABN) |
| ACH |
Automated Clearing House |
| ACPOE |
Ambulatory Computerized Physician
Order Entry |
|
ACROFILE |
Complete Consumer Credit Report
(Equifax) |
| ACS |
Automated Claim Status |
| ADA |
American Dental Association |
| ADE |
Adverse Drug Event |
|
ADIC |
Ambulatory Diagnostic Imaging
Center (Independent Radiology) |
| ADR |
Additional Development/Documentation
Request |
| ADT |
Admission Discharge & Transfer |
| AFDC |
Aid to Families With Dependent
Children |
| AHA |
American Hospital Association |
| AHCA |
American Health Care Association |
| AHIP |
America's Health Insurance Plans |
| AHRQ |
Agency for Healthcare Researach &
Quality |
|
AKL |
Federal Anti-Kickback
Legislation |
| ALF |
Assisted Living Facility |
| ALJ |
Administrative Law Judge |
| ALOS |
Average Length of Stay |
| AHIMA |
American Health Information
Management Association |
| ANSI |
American National Standards
Institute - Approved standards developing organization in healthcare arena |
| AMA |
American Medical Association |
| AMIA |
American Medical Informatics
Association |
| AOB |
Assignment of Benefits |
| APC |
Ambulatory Payment Classification |
| APDRG |
All Patient Diagnostic Related
Grouping |
| APG |
Ambulatory Patient Groups (See APC) |
| APTA |
American Physical Therapy
Association |
| ARDEN
Syntax |
Standard (sponsored by HL7) formal
procedure language that represents medical algorithms in clinical information
systems as knowledge modules |
| ASC |
Ambulatory Surgical Center |
| ASCII |
American Standard Code for
Information Exchange |
| ASCP |
American Society for Clinical
Pathology |
| ASP |
Application Service Provider |
| ASTM |
American Society for Testing and
Materials |
|
AUTHORIZATION |
See
pre-cert |
| AWP |
Average Wholesale Price |
|
BA |
Business Associate |
| BAA |
Business Associate Agreement |
| BA/R |
Billing Accounts Receivable |
| BBA |
Balanced Budget Act of 1997 |
| BIPA |
Benefits Improvement and Protection
Act of 2000 |
| BBRA |
Balanced Budget Refinement Act of
1999 |
| BS |
BatchSource (Passport Product
Abbreviation) |
|
Carrier |
Insurance Company that administers
Medicare Part B |
| CAH |
Critical Access Hospital |
| CAQH |
Council for Affordable Quality
Healthcare |
|
CAS |
Compliance Analyzer Service |
| CAT |
Computed Axial Tomography (see CT) |
| CBO |
Central Billing Office |
| CCAP |
Compliance Checker™ All Payer |
| CC |
Complication & Co Morbidity |
| CCI |
Correct Coding Initiative |
| CCN |
Care Core National (Radiology
Benefits Management Company) |
| CCO |
Chief Compliance Officer |
| CCOW |
Clinical Content Objective Workgroup
(One of the HL7 Standards) |
| CCP |
Credit Card Processor |
|
CDHP |
Consumer-Directed Health Plan |
| CDM |
Charge Description Master |
| CDSS |
Clinical Decision Support System
|
| CDT |
Current Dental Terminology |
| CE |
Covered Entity |
| CFR |
Code of Federal Regulations (Federal
Register) |
| CHAMPUS |
Civilian Health and Medical Program,
Uniformed Services (Now TriCare) |
| CHAMPVA |
Civilian Health and Medical Program,
Veteran Affairs (Not Same As TriCare) |
|
CHIM |
Center For Healthcare
Information Management |
| CHIN |
Community Health Information Network |
| CIA |
Corporate Integrity Agreement |
| CICA |
Context Inspired Component
Architecture (ASC X12's syntax neutral architecture) |
| CICS |
Customer Information Control System |
|
CIM |
Medicare Coverage Issues
Manual |
| CIO |
Chief Information Officer |
| CLIA |
Clinical Laboratory Improvement
Ammendment |
|
CLMA |
Clinical Laboratory Management
Association |
|
CM |
Case Manager |
| CMN |
Certificate of Medical Necessity |
| CMP |
Competitive Medical Plans |
|
CMS |
Centers for Medicare and
Medicaid Services |
| CNM |
Certified Nurse Midwife |
|
COB |
Coordination of Benefits |
| COBRA |
The Consolidated Omnibus Budget
Reconciliation Act of 1985 |
| COI |
Complexity of Illness |
| COLD |
Computer Output to Laser Disk |
| CORE |
Committee on Operating Rules For
Information Exchange |
| CPC® |
Certified Professional Coder
(American Academy Professional Coders) |
| CPC-H |
Certified Professional Coder -
Hospital |
| CPC-P |
Certified Professional Coder - Payer |
|
CPI |
Consumer Price Index |
|
CPOE |
Computerized Physician Order
Entry (Usually Pharmacy Orders) |
|
CPT-4® |
Current Procedural Terminology
- 4th Edition |
|
CQI |
Continuous Quality Improvement |
|
CR |
Change Request (ID Number
Assigned to a CMS Transmittal |
| CRA |
Credit Reporting Agency |
| CRT |
Cost Revenue Table (See CDM) |
|
CSPC |
Claims Status Productivity
Center |
| CT |
Computed Axial Tomography (see CAT) |
|
CTO |
Chief Technology Officer |
| CY |
Calendar Year |
|
DAB |
Department of Appeals Board
(Related to Medicare Appeals) |
|
DDE |
Direct Data Entry |
| DEA |
Data Encryption Algorithm or Drug
Enforcement Administration |
|
DEFRA |
Deficit Reduction Act of 1984 |
| DES |
Data Encryption Standard |
|
DHHS |
Department of Health and Human
Services |
|
DISA |
Data Interchanges Standards
Association |
|
DME |
Durable Medical Equipment |
|
DMEPOS |
Durable Medical Equipment -
Prosthetics, Orthotics & Supplies |
|
DMERC |
Durable Medical Equipment
Regional Carrier (DME Claims Processing) |
| DOB |
Date of Birth |
|
DOJ |
Department of Justice |
| DPAHC |
Durable Power of Attorney Healthcare |
|
DRG |
Diagnostic Related Grouping |
| DSH |
Disproportionate Share Hospital |
| DTC |
Direct to Consumer |
| Dx |
Shorthand for Diagnosis |
|
EBM |
Employee Benefits Manager |
| EBP |
Evidence Based Practice |
| EBT |
Electronic Benefit Transfer |
|
eBXML |
Electronic Business XML (a
suite of specifications for conducting business over the internet |
| ECF |
Extended Care Facility |
| ECI |
Employment Cost Index |
| ED |
Emergency Department |
| EDC |
Enterprise Data Center |
|
EDI |
Electronic Data Interchange |
| EFSnet |
Concord/First Data Web Payment
Services |
|
EFT |
Electronic Funds Transfer |
| EFX |
Equifax |
|
EHNAC |
Electronic Healthcare Network
Accreditation Commission |
| EHR |
Electronic Health Record |
|
EIN |
Employer Identification Number |
|
ELIGIBILITY |
Insurance policy terms that define
who is eligible to get coverage and the requirements for receiving coverage.
These may include length of employment with the plan sponsor, job status and
other provisions. |
|
E&M |
Evaluation and Management
Coding System |
|
EMC |
Electronic Media Claims |
|
EMR |
Electronic Medical Record |
| EMS |
Emergency Medical Services |
| EMTALA |
Emergency Treatment & Active Labor
Act |
| ENT |
Enteral Nutrition Therapy |
|
EOB |
Explanation of Benefits |
|
EOMB |
Explanation of Medical
Benefits |
| EPR |
Electronic Patient Record
(Alternative to EMR) |
| EPSDT |
Early and Periodic Screening,
Diagnosis and Treatment |
| ER |
Emergency Room |
|
ERA |
Electronic Remittance Advice
(835) |
|
ERISA |
Employee Retirement Income
Security Act |
|
ESRD |
End Stage Renal Disease |
|
FACT |
Fair and Accurate Credit
Transactions Act of 2003 |
|
FAR |
Federal Acquisition Regulation |
|
FCA |
False Claims Act |
|
FCC |
Federal Communications
Commission |
| FCRA |
Fair Credit Reporting Act |
|
FDA |
Food and Drug Administration |
|
FDC |
Federal District Court |
|
FEC |
Front-end Collections |
| FECA |
Federal Employees Compensation Act |
|
FFS |
Fee for Service |
|
FI |
Fiscal Intermediary (insurance
company that administers Medicare Part A) |
| FIFO |
First In First Out (Inventory
Method) |
|
FISS |
Fiscal Intermediary Standard
System |
| FPL |
Federal Poverty Level |
| FQHC |
Federally Qualified Health Center |
| FRB |
Federal Reserve Board |
|
FSA |
Flexible Spending Account |
| FSRRA |
Financial Services Regulatory Relief
Act of 2006 |
|
FSS |
Florida Shared System |
| FTC |
Federal Trade Commission |
| FTE |
Full Time Equivalent |
| FUL |
Federal Upper Limit |
|
FUS |
Follow Up System |
| Fx |
Shorthand for Fracture |
| FY |
Fiscal Year |
|
GAF |
Geographic Adjustment Factor |
|
GAO |
General Accounting Office |
| GLBA |
The Gramm-Leach-Bliley Act |
| GME |
Graduate Medical Education |
|
HBA |
Health & Beauty Aids |
| HBOT |
Hyperbaric Oxygen Therapy |
| HCBS |
Home and Community Based Services |
| HCC |
Hierarchical Coexisting Condition |
|
HCCA |
Health Care Compliance
Association |
|
HCFA |
Health Care Financing
Administration (Now Known as CMS) |
|
HCFA 1450 |
Universal form used to bill
Part A hospital-based service to FI (UB-92) |
|
HCFA 1500 |
Universal form for billing
professional services to Part B carrier (CMS- 1500) |
|
HCPCS |
Healthcare Common Procedural
Coding System |
| HCPP |
Healthcare Pre-Payment Plan |
| HCRIS |
Hospital Cost Report Information
System |
|
HDHP |
High Deductible Health Plan |
|
HEDIS |
Health Employer Data &
Information |
| HETS |
HIPAA Eligibility Transaction System
|
|
HFMA |
Healthcare Financial
Management Association |
|
HHA |
Home Health Agency |
|
HHABN |
Home Health ABN |
|
HHS |
Department of Health and Human
Services |
|
HIAA |
Health Insurance Association
of America |
| HIC |
Health Insurance Card |
|
HIM |
Health Information Management |
|
HIMSS |
Health Information Management
Society |
| HIN |
Healthcare Identification Number |
|
HINN |
Hospital Issued Notice of
Non-Coverage |
|
HINN 11 |
New HINN for use with
diagnostics etc., not bundled to Inpatient Care |
|
HIPAA |
Health Insurance Portability
and Accountability Act of 1996 |
|
HISB |
Health Information Standards
Board |
|
HIT |
Health Information Technology |
|
HL7 |
Health Level 7 Interface
requirements for healthcare organization |
|
HMO |
Health Maintenance
Organization |
| HPI |
History of Present Illness |
| HQA |
Hospital Quality Assurance |
| HQI |
Hospital Quality Initiative |
|
HR4157 |
Health Information Technology
Promotion Act of 2006 |
|
HRA |
Health Reimbursement Account |
|
HSA |
Health Savings Account |
| HSRV |
Hospital Specific Relative Value |
| Hx |
Shorthand for History |
|
ICD-9 |
International Classification
Disease - 9th Edition (Diagnosis Coding System Current) |
|
ICD-10 |
International Classification
Disease - 10th Edition (Diagnosis Coding System Proposed) |
| ICF |
Intermediate Care Facility |
|
ICN |
Internal Control Number |
|
IDN |
Integrated Delivery Network |
| IHDN |
Integrated Healthcare Delivery
Network |
| IHN |
Integrated Healthcare Network |
| IHP |
Indemnity Health Plan |
| IHS |
Indian Health Service or Integrated
Health System |
|
IOM |
Institute of Medicine |
|
IP |
Inpatient |
| IPCARE |
Service provided after a patient is
admitted to the hospital. Inpatient care lasts 24 hours or more. |
| IPF |
Inpatient Psychiatric Facility |
| ISMN |
IntelliSource - Medical Necessity |
|
ISN |
Integrated Services Network |
|
ISO |
International Standards
Organization - Networks of National Standards Institute of 146 Countries |
|
IS |
Information Systems |
| IS |
IntelliSource (Passport Product
Abbreviation) |
|
ISP |
Internet Services Provider |
|
IPPS |
Acute Care Hospital Inpatient Prospective Payment
System |
|
JCAHO |
Joint Commission on
Accreditation of Healthcare Organizations |
|
J-Code |
A subset of HCPCS Level II
(Used to identify certain drugs) |
|
JHITA |
Joint Healthcare Information
Technology Alliance |
|
LMRP |
Local Medical Review Policy
(Obsolete 12/2005) |
|
LCD |
Local Coverage Determination
(Formerly known as LMRP) |
|
LEIE |
List of Excluded Individuals
and Entities |
| LIFO |
Last In First Out (Inventory) |
| LIS |
Laboratory Information System |
|
LOINC® |
Logical Observation Identifier
Names and Codes |
|
LOOP |
A repeating Structure or
Process |
| LOS |
Length of Stay |
|
LTC |
Long Term Care |
| LTCF |
Long Term Care Facility |
|
MA |
Medicare Advantage |
|
MAC |
Medicare Appeals Council |
|
MAC |
Medicare Administrative
Contractor (Future replacement for Medicare FI/Carrier System) |
| MCC |
Major Complication & Co Morbidity |
|
MCO |
Managed Care Organization |
| MCPI |
Medical Consumer Price Index |
|
MCM |
Medical Case Management |
| MCS |
Medical Credit Score |
| MDC |
Major Diagnostic Categories |
| MDH |
Medicare Dependent Hospital |
|
Meditech |
Medical Information Technology, Inc.
(MA-based software and service company) |
| MedPac |
Medicare Payment Advisory Commission |
| MEI |
Medicare Electronic Index |
|
MGMA |
Medical Group Management
Association |
|
MLN |
Medicare Learning Network |
| MLT |
Medical Laboratory Technician |
|
MMA |
Medicare Modernization Act of
2003 |
|
MM |
Medical Management |
|
MPI |
Master Patient (or Person)
Index |
| MPN |
Medicare Provider Number |
|
MR |
Medical Review |
| MRI |
Magnetic Resonance Imaging |
| MSA |
Medicare Statistical Area or Medical
Savings Account |
| MS-DRG |
Medicare Severity Diagnostic Related
Groups (Medicare Reimbursement) |
|
MSP |
Medicare Secondary Payer |
|
MT |
Medical Technologist |
| MTF |
Medical Treatment Facility |
|
M+C |
Medicare+Choice |
|
M+CO |
Medicare+Choice Organization |
|
MIP |
Medicare Integrity Program |
|
MLP |
Mid Level Practitioner (RNP
PA) |
|
MORCASH |
Medicare Outpatient Revenue
Collection Assessment Service - Hospital |
|
MSA |
Medical Savings Account |
|
MSO |
Management Services
Organization |
|
MSP |
Medicare Secondary Payer |
|
MUE |
Medically Unlikely Edits |
| Mx |
Shorthand for Metastasis |
|
NAHAM |
National Association of
Healthcare Access Management |
|
NAHDO |
National Association of Health
Data Organizations |
|
NAIC |
National Association of
Insurance Commissioners |
| NCA |
National Credentialing Association |
|
NCD |
National Coverage
Determination |
| NCHS |
National Center for Health
Statistics |
| NCQA |
National Committee for Quality
Assurance |
| NCVHS |
National Committee on Vital and
Health Statistics |
| NDA |
Non Disclosure Agreement |
|
NDC |
National Drug Code |
|
NEIC |
National Electronic
Information Corporation |
|
NEMB |
Notice of Exclusion of
Medicare Benefit |
| .Net |
Microsoft strategy for connecting
systems, information & devices via web services |
| NHS |
National Health Service |
| NIA |
National Imaging Associates
(Radiology Benefits Management Company) |
| NIH |
National Institutes of Health |
| NMR |
Nuclear-Magnetic Resonance |
| NOI |
Notice of Intent |
|
NPI |
National Provider ID |
|
NPRM |
Notice of Proposed Rule Making |
| NQF |
National Quality Forum |
| NSA |
Non surgical admission |
|
NSF |
National Standard Format |
| NTIS |
National Technical Information
Service |
|
NUBC |
National Uniform Billing
Committee |
|
NUCC |
National Uniform Claim
Committee |
| NVHRI |
National Voluntary Hospital
Reporting Initiative |
|
OAA |
Old Age Assistance Program |
|
OAS |
Office of Audit Services |
| OASIS |
Outcome and Assessment Information
Set |
|
OB |
Obstetrics |
| OBC |
Orange Book Code |
| OBRA |
Omnibus Budget Reconciliation Act |
|
OBS |
Observation Services |
|
OCE |
Outpatient Code Editor |
|
OCR |
Office of Civil Rights |
|
OIG |
Office of the Inspector
General |
|
OMB |
Office of Management Budget |
|
OmniLinkSM |
McKesson centralized pharmacy
software |
| OON |
Out of Network |
| OOP |
Out of Plan |
|
OP |
Outpatient |
| OPCARE |
Care provided in a clinic, emergency
room, hospital or non-hospital surgical center, without admitting the patient. |
|
OPD |
Outpatient Department |
|
OPPS |
Outpatient Prospective Payment
System |
| OS |
OneSource (Passport Product
Abbreviation) |
|
OSI |
Open System Interconnection |
| OT |
Occupational Therapy |
|
PAT |
Pre-Admission Testing |
|
P/Bar |
Patient/Billing Accounts Receivable
System |
| PBM |
Pharmacy Benefits Manager |
|
PCATM |
Pre-submission Compliance
Analyzer |
| PCP |
Primary Care Physician |
|
PDP |
Prescription Drug Plan |
| PET |
Positive Emission Tomography |
|
PFOS |
Patient Financial Obligation
Statement |
|
PHB |
Pharmacy Benefits Manager |
| PHCP |
Primary Health Care Physician or
Provider |
|
PHI |
Protected Health Information |
| PHO |
Physician Hospital Organization |
| PHS |
Public Health Service |
|
PIC |
Passport IntelliSource Client |
| PKI |
Public Key Infrastructure |
| PL |
Patient Locator |
|
PM |
Program Memorandum |
| PMH |
Patient Medical History |
| PMPM |
Per Member Per Month |
|
PM/R |
Physical Medicine/
Rehabilitation (PT - OT & Speech Therapy) |
|
PMS |
Practice Management System
(Physicians Office Environment) |
| POC |
Plan of Care or Point of Care -
Proof of Coverage |
|
POS |
Point (or Place) of Service |
| PPA |
Preferred Provider Arrangement |
| PPI |
Provider Price Index |
|
PPO |
Preferred Provider
Organization |
| PPR |
Paper Based Patient Record |
|
PPS |
Prospective Payment System |
|
PRA |
Paperwork Reduction Act |
|
PRECERT |
The process of receiving approval
for some health care, such as hospitalization, outpatient surgery or
prescription drugs, before it can be covered. |
|
PRG |
Procedure Related Group |
| PRM |
Provider Reimbursement Group |
|
PRO |
Peer Review Organization |
| PSH |
Patient Surgical History |
| PSN |
Provider Sponsored Networks |
| PT |
Physical Therapy |
|
PTD |
Payer Transaction Density |
| Px |
Shorthand for Procedure |
|
QIC |
Qualified Independent
Contractor (Related to Medicare Appeals) |
| QIO |
Quality Improvement Organization |
|
RA |
Remittance Advice (ERA - 835) |
| RAC |
Recovery Audit Contractor |
| RBRVS |
Resource Based Relative Value Scale |
|
REFERRAL |
Specific directions or instructions
from a member's PCP that directs a member to a participating health care
professional for medically necessary care. A referral may be written or
electronic. |
|
RHIO |
Regional Health Information
Organization |
| RHIT |
Registered Health Information
Technician |
| RN |
Registered Nurse |
| RRA |
Registered Records Administrator |
|
RRAS |
Request and Response
Aggregation Support |
| RRT |
Registered Respiratory Therapist |
|
RTE |
Response Transaction
Embellishment |
| RUG |
Resource Utilization Groups |
|
RVS |
Relative Value Scale |
| RVU |
Relative Value Unit |
| Rx |
Shorthand for Prescription |
| RY |
Rate Year |
|
SCH |
Sole Community Hospital |
|
SCHIP |
State Children's Health
Insurance Program (Reference Medicaid) |
|
SDC |
Surgical Day Care |
| SFY |
State Fiscal Year |
| SIC |
Standard Industrial Classification |
| SMS |
Shared Medical Systems |
|
SNF |
Skilled Nursing Facility |
|
SNIP |
Strategic National
Implementation Process (A WEDI program) |
|
SNOMED |
Systematized Nomenclature of
Medicine |
| SOAP |
Subjective Objective Assessment &
Plan (Charting System) |
| SOC |
Standard Occupational
Classifications |
| SOM |
State Operations Manual |
|
SOW |
Statement of Work |
| SP |
Self Pay |
|
SSA |
Social Security Administration |
| SSI |
Supplemental Security Income |
|
SSN |
Social Security Number |
|
SSO |
Standard Setting Organization |
|
S&S |
Store & Serve |
|
SQL |
Structured Query Language -
Software language used to talk to most databases |
|
SUNQUEST |
Laboratory Information System Brand
Name |
|
SWG |
Sub Work Group |
| Sx |
Shorthand for symptoms |
|
TAG |
Technical Advisory Group |
| TCP/IP |
Transmission Control
Protocol/Internet Protocol |
|
TPA |
Third Party Administrator
(Healthcare Claims Processing Entity) |
|
TPO |
Treatment Payment &
Healthcare Operations |
|
TPP |
Transaction Processing
Platform |
|
TPR |
Transaction Protocol
Redirection |
| Tx |
Shorthand for Treatment |
|
UAT |
User Acceptance Testing |
|
UB |
Uniform Bill |
|
UB-04 |
Universal Billing Form (paper)
replacing UB-92 by March 2007 |
|
UB-92 |
Universal Billing Form used to
bill Part A hospital based service to FI (HCFA 1450) |
|
UCF |
Uniform Claim Form |
|
UCR |
Usual Customary and Reasonable
fees |
|
UDRVs |
User Definable Response Views |
| UHDDS |
Uniform Hospital Discharge Data Set |
|
UHIN |
Utah Health Information
Network |
|
UM |
Utilization Management (aka
Medical Management) |
|
UOS |
Units of Service |
| UPC |
Universal Product Code |
|
UPIN |
Unique Physician
Identification Number |
| UPL |
Upper payment limit |
| URL |
Uniform Resource Locator |
|
UROE |
Universal Remote Order Entry |
| UR |
Utilization Review (Case Management) |
|
USC |
United State Code |
|
VAN |
Value Added Network |
|
VAR |
Value Added Reseller |
| VHA |
Veterans Hospital Administration |
|
VIPS |
Viable Information Processing
System |
|
VPN |
Virtual Private Network |
|
WEDI |
Workshop for Electronic Data
Interchange |
|
WG |
Workgroup |
|
WHO |
World Health Organization |
| WIC |
Women's Infants & Children (Special
Supplemental Nutrition Program) |
|
WPC |
Washington Publishing Company |
|
XACTION |
Transaction |
|
XML |
Extensible Markup Language -
Standards for HL7's entire platform |
| XSL |
XML Style Sheet Language |
|
X12 |
An ANSI-accredited group that
defines EDI standards for many American industries, including healthcare
insurance |
|
X12 270 |
The X12 Healthcare Eligibility
& Benefit Inquiry Transaction |
|
X12 271 |
The X12 Healthcare Eligibility
& Benefit Response Transaction |
|
X12 276 |
X12 Claim Status Inquiry |
|
X12 277 |
X12 Claims Status Response |
| X12 278 |
Referral, pre-certification or
authorization inquiry or submit |
|
X12 834 |
X12 Enrollment & Maintenance
Transaction |
|
X12 835 |
X12 Healthcare Claim Payment
and Remittance Advice Transaction |
|
X12 837 |
X12 Healthcare Claim or
Encounter Transaction |
| X12
837i |
See X12 837 Institutional Version |
| X12
837p |
See X12 837 Professional Version |
| ZPP |
Medicare HMO Zero Premium Plans |
