| AAPC |
American Association of Professional Coders |
| ABN |
Advance Beneficiary Notice of Noncoverage |
| ACA |
Affordable Care Act |
| ACH |
Automated Clearing House |
| ACO |
Administrative Contracting Officer |
| ACT |
Ask-the-Contractor Teleconference |
| ADR |
Additional Documentation Request |
| AG |
Advisory Group |
| ALJ |
Administrative Law Judge |
| AMA |
American Medical Association |
| ANSI |
American National Standards Institute |
| ASP |
Average Sales Price |
| AWP |
Average Wholesale Price |
| BCRC |
Benefits Coordination & Recovery Center (formerly Coordination of Benefits Contractor) |
| BPCI |
Bundled Payment for Care Improvement |
| CAC |
Contractor Advisory Committee |
| CARC |
Claim Adjustment Reason Code |
| CB |
Consolidated Billing |
| CBSA |
Core Based Statistical Area |
| CDC |
CERT Documentation Contractor |
| CERT |
Comprehensive Error Rate Testing |
| CFR |
Code of Federal Regulations |
| CHIP |
Children’s Health Insurance Program |
| CHOW |
Change of Ownership |
| CID |
Claim Identifier |
| CMD |
Contractor Medical Director |
| CMS |
Centers for Medicare & Medicaid Services |
| COB |
Coordination of Benefits |
| COBA |
Coordination of Benefits Agreement |
| CPO |
Care Plan Oversight |
| CPT |
Current Procedural Terminology |
| CR |
Change Request |
| CSR |
Customer Service Representative |
| CWF |
Common Working File |
| CY |
Calendar Year |
| DCN |
Document Control Number |
| DME |
Durable Medical Equipment |
| DMERC |
Durable Medical Equipment Regional Carrier |
| DMEPOS |
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies |
| DNF |
Do Not Forward |
| DOS |
Dates of Service |
| ED |
Expedited Determination |
| EDI |
Electronic Data Interchange |
| EFT |
Electronic Funds Transfer |
| EIDM |
Enterprise Identity Management System |
| EIN |
Employer Identification Number |
| EMC |
Electronic Media Claims |
| EOB |
Explanation of Benefits |
| ERS |
Extended Repayment Schedule (formerly Extended Repayment Plan or ERP) |
| ERA |
Electronic Remittance Advice |
| ERP |
Extended Repayment Plan |
| esMD |
Electronic Submission of Medical Documentation |
| FAQ |
Frequently Asked Question |
| FB |
Forward Balance |
| FDG |
Fluorodeoxyglucose |
| FFS |
Fee-For-Service |
| FOIA |
Freedom of Information Act |
| FTP |
File Transfer Protocol |
| FY |
Fiscal Year |
| GEMs |
General Equivalence Mappings |
| GHP |
Group Health Plan |
| HCPCS |
Healthcare Common Procedure Coding System |
| HETS |
HIPAA Eligibility Transaction System |
| HIC or HICN |
Health Insurance Claim Number |
| HIGLAS |
Healthcare Integrated General Ledger Accounting System |
| HIPAA |
Health Insurance Portability & Accountability Act |
| HPTC |
Healthcare Provider Taxonomy Code |
| HUD |
Humanitarian Use Device |
| IACS |
Individuals Authorized Access to CMS Computer System |
| ICD-9-CM |
International Classification of Diseases – Ninth Edition – Clinical Modification |
| ICD-10-CM |
International Classification of Diseases – Tenth Edition – Clinical Modification |
| I/OCE |
Integrated Outpatient Code Editor |
| IOM |
Internet Only Manual |
| IVR |
Interactive Voice Response |
| LCD |
Local Coverage Determination |
| LGHP |
Large Group Health Plan |
| LPN |
Licensed Practical Nurse |
| MA |
Medicare Advantage |
| MAC |
Medicare Administrative Contractor |
| MCD |
Medicare Coverage Database |
| MD |
Doctor of Medicine |
| MLN |
Medicare Learning Network |
| MMA |
Medicare Modernization Act |
| MPFS |
Medicare Physician Fee Schedule |
| MPFSDB |
Medicare Physician Fee Schedule Database |
| MPPR |
Multiple Procedure Payment Reduction |
| MR |
Medical Review |
| MSP |
Medicare Secondary Payer |
| MSN |
Medicare Summary Notice |
| MUE |
Medically Unlikely Edit |
| NCCI |
National Correct Coding Initiative |
| NCD |
National Coverage Determination |
| NDC |
National Drug Code |
| NF |
Nursing Facility |
| NOC |
Not Otherwise Classified |
| NOS |
Not Otherwise Specified |
| NP |
Nurse Practitioner |
| NPI |
National Provider Identifier |
| NPP |
Non-Physician Practitioner |
| NPPES |
National Plan and Provider Enumeration System |
| NPR |
Notice of Program Reimbursement |
| NSV |
Network Service Vendor |
| OIG |
Office of Inspector General |
| OPPS |
Outpatient Prospective Payment System |
| OPR |
Overpayment Recovery |
| OSCAR |
Online Survey Certification & Reporting System |
| OT |
Occupational Therapy |
| OTAF |
Obligated to Accept as Payment in Full |
| PACE |
Program of All-inclusive Care of the Elderly |
| PCA |
Progressive Corrective Action |
| PCC |
Provider Contact Center |
| PDF |
Portable Document Format |
| PE |
Provider Enrollment |
| PECOS |
Provider Enrollment Chain and Ownership System |
| PET |
Positron Emission Tomography |
| PHI |
Protected Health Information |
| PIM |
Program Integrity Manual |
| POC |
Plan of Care |
| POE |
Provider Outreach and Education |
| PPV |
Pneumococcal Pneumonia Vaccine |
| PQRS |
Physician Quality Reporting System |
| PT |
Physical Therapy |
| PTAN |
Provider Transaction Access Number |
| PUF |
Public Use Files |
| PWK |
Paperwork Segment |
| QIC |
Qualified Independent Contractor |
| QIO |
Quality Improvement Organization |
| QIP |
Quality Incentive Program |
| RA |
Recovery Auditor |
| RA |
Remittance Advice |
| RAC |
Recovery Audit Contractor (now called Recovery Auditor) |
| RARC |
Remittance Advice Remark Code |
| RN |
Registered Nurse |
| RO |
Regional Office |
| RTP |
Return to Provider |
| SLP |
Speech-Language Pathology |
| SMRC |
Supplemental Medical Review Contractor |
| SPR |
Standard Paper Remittance |
| SSA |
Social Security Administration |
| SSI |
Supplemental Security Income |
| TIN |
Tax Identification Number |
| VA |
Veterans Administration |
| WC |
Workers’ Compensation |
| WO |
Withhold |