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 |