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Acronym
|
Definition
|
|
ABN
|
Advance Beneficiary Notice
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ALJ
|
Administrative Law Judge
|
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ALS
|
Advanced Life Support (ambulance)
|
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ANSI
|
American National Standards Institute
|
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ASC
|
Ambulatory Surgical/
Surgery
Center
|
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ASCA
|
Administrative Simplification Compliance Act
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AWP
|
Average Wholesale Price (drugs)
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ASP
|
Average
Sale Price
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BBA
|
Balanced Budget Act of 1996
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BIPA
|
'Medicare, Medicaid & SCHIP' Benefits Improvement & Protection Act of 2000
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BLS
|
Basic Life Support (ambulance)
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CARC
|
Claim Adjustment Reason Code
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CB
|
Consolidated Billing
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CBIC
|
Competitive Bidding Implementation Contractor
|
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CCI
|
Correct Coding Initiative
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CCN
|
Claim Control Number
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CDC
|
Center for Disease Control
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CERT
|
Comprehensive Error Rate Testing program
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CFR
|
Code of Federal Regulations
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CHC
|
Comprehensive
Health
Center
|
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CLIA
|
Clinical Laboratory Improvement Act
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CMHC
|
Community Mental Health Center
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CMN
|
Certificate of Medical Necessity
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CMR
|
Comprehensive Medical Review
|
|
CMS
|
Centers for Medicare & Medicaid Services
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CNS
|
Clinical Nurse Specialist
|
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COA
|
Change of Address
|
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COB
|
Close of Business
|
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COB
|
Coordination of Benefits
|
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COBC
|
Coordination of Benefits Contractor
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COBRA
|
Consolidated Omnibus Budget Reconciliation Act of 1985
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CORF
|
Comprehensive Outpatient Rehabilitation Facility
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CPT-4
|
Current Procedural Terminology
|
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CR
|
Change Request
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CRNA
|
Certified Registered Nurse Anesthetist
|
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CSW
|
Clinical Social Worker
|
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CWF
|
Common Working File
|
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CWF/MSP
|
Common Working File / Medicare Secondary Payer
|
|
DAB
|
Departmental Appeals Board (ALJ)
|
|
DHHS
|
Department of Health and Human Services
|
|
DHS
|
Designated health services
|
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DMAC
|
DME Medicare Administrative Contractor
|
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DME
|
Durable Medical Equipment
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DMEPOS
|
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
|
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DMERC
|
Durable Medical Equipment Regional Carrier
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DOE
|
Date of Entitlement
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DOS
|
Date of Service
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ED
|
Emergency Department
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EDI
|
Electronic Data Interchange
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EFT
|
Electronic Funds Transfer
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EGHP
|
Employer Group Health Plan
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EIN
|
Employer Identification Number
|
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E/M
|
Evaluation and Management
|
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EMT
|
Emergency Medical Technician
|
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EMTALA
|
Emergency Medical Treatment & Active Labor Act
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EOB
|
Explanation of Benefits
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ERA
|
Electronic Remittance Advice
|
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ERN
|
Electronic Remittance Notice
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ESRD
|
End Stage Renal Disease
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FAQ
|
Frequently Asked Question
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FDA
|
Food & Drug Administration
|
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FFS
|
Fee-for-Service
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FI
|
Fiscal Intermediary
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FISS
|
Fiscal Intermediary Shared (or Standard) System
|
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FQHC
|
Federally Qualified Health Center
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FR
|
Federal Register
|
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FY/CY
|
Fiscal Year/Calendar Year
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GBA
|
Government Benefits Association
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HCPCS
|
Health Care Procedure Coding System
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HHA
|
Home Health Agency
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HHS
|
Department of Health & Human Services
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HIC
|
Health Insurance Claim
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HICN
|
Health Insurance Claim Number (Medicare Number)
|
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HIMR
|
Health Insurance Master Record (Social Security)
|
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HIPAA
|
Health Insurance Portability and Accountability Act of 1996
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HMO
|
Health Maintenance Organization
|
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HPSA
|
Health Professional (or Personnel) Shortage Area
|
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ICD-9-CM
|
International Classification of Diseases, 9th Revision, Clinical Modification
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ICN
|
Internal Control Number
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IDE
|
Investigational Device Exemption
|
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IDTFs
|
Independent Diagnostic Testing Facilities
|
|
IG
|
Implementation Guide (HIPAA)
|
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IPPS
|
Inpatient Prospective Payment System
|
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IVR
|
Interactive Voice Response
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LCD
|
Local Coverage Determination (medical policy)
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LOC
|
Level of Care
|
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LTC
|
Long Term Care
|
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LTCF
|
Long Term Care Facility
|
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MA-PD
|
Medicare Advantage Prescription Drug Plans
|
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MA Plan
|
Medicare Advantage Plan (formerly “Medicare+Choice” or “Medicare HMO”)
|
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MAC
|
Medicare Administrative Contractor
|
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MCO
|
Managed Care Organizations
|
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MEDIGAP
|
A Medicare complementary insurance program
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MEI
|
Medicare Economic Index
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MPFSDB
|
Medicare Physician Fee Schedule Data Base
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MR
|
Medical Review
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MSN
|
Medicare Summary Notice (notice to beneficiaries)
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MSP
|
Medicare Secondary Payer
|
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NCD
|
National Coverage Determination
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NDC
|
National Drug Code
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NOC
|
Not Otherwise Classified
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NP
|
Nurse Practitioner
|
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NPI
|
National Provider Identifier
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NPP
|
Non-physician Practitioner
|
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NPPES
|
National Plan and Provider Enumeration System
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OBRA
|
Omnibus Budget Reconciliation Act
|
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OCR
|
Optical Character Recognition
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OIG
|
Office of Inspector General
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OPPS
|
Outpatient Prospective Payment System
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OTAF
|
Obligated to Accept as Payment in Full
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OTC
|
Over the Counter Drug
|
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PA
|
Physician Assistant
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PC
|
Professional Component
|
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PCC
|
Provider
Contact
Center
|
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PCP
|
Primary Care Physician (or Provider)
|
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PDP
|
Prescription Drug Plan
|
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PDR
|
Physician's Desk Reference
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PECOS
|
Provider Enrollment, Chain & Ownership System
|
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PFS
|
Physician Fee Schedule
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PHI
|
Protected Health Information (see also: HIPAA)
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PIN
|
Provider Identification Number (see also: PTAN)
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POS
|
Place of Service
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PPO
|
Preferred Provider Organization
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PPS
|
Prospective Payment System
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PQRI
|
Physician Quality Reporting Initiative
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PR
|
Patient Responsibility
|
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PSC
|
Program Safeguard Contractor
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PTAN
|
Provider Transaction Access Number (formerly PIN)
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QIC
|
Qualified Independent Contractor
|
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QIO
|
Quality Improvement Organization
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RA
|
Remittance Advice
|
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RAC
|
Recovery Audit Contractor
|
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RARC
|
Remittance Advice Remark Code
|
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RBRVS
|
Resource Based Relative Value Scale
|
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RHC
|
Rural Health Clinic
|
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RHHI
|
Regional Home Health Intermediary
|
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RO
|
Regional Office (CMS)
|
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RT
|
Respiratory Therapy
|
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RVS
|
Relative Value Scale
|
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RVU
|
Relative Value Unit
|
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SCHIP
|
State Children's Health Insurance Program
|
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SHIPs
|
State Health Insurance Plan
|
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SNC
|
Skilled Nursing Care
|
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SNF
|
Skilled Nursing Facilities
|
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SSA
|
Social Security Administration
|
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SSI
|
Supplemental Security Income
|
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SSN
|
Social Security Number
|
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TEFRA
|
Tax Equity & Fiscal Responsibility Act of 1982 (PL97248)
|
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TENS
|
Transcutaneous Electrical Nerve Stimulation
|
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TIN
|
Tax Identification Number
|
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TOS
|
Type of Service
|
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TTY
|
Text Telephones
|
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UPIN
|
Unique Provider Identification Number
|
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USP
|
U.S. Pharmacopoeia
|
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WEDI
|
Workgroup for Electronic Data Interchange
|
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WHO
|
World Health Organization
|
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ZIP
|
Zoning Improvement Plan (ZIP Codes)
|