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October 30, 2014 - Revised: 12.11.15

Part B Acronyms


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

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