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APC Ambulatory Payment Class (payment type under outpatient PPS)
Assigned Claims Claims from Part B provider, accepted as payment in full
BBA Balanced Budget Act (1997)
BBRA Balanced Budget Refinement Act (1999)
Carrier Company through whom Medicare Part B Claims are submitted to HCFA
CCI Correct Coding Initiative (type of edit to detect unbundling of claims or claims that should not appear together)
CD-RISC Clinically Detailed Risk Information System for Costs (type of
comprehensive risk adjustment model)
CHPP Center for Health Plans and Providers
CLIA Clinical Laboratory Improvement Amendments
CMS Centers for Medicare and Medicaid Services (formerly HCFA)
COB Coordination of Benefits
CORF Comprehensive Outpatient Rehabilitation Facility
CPO Care Plan Oversight (category of claims for home health services)
CR Change Request
CPT-4 Current Procedural Terminology, 4th edition (for coding physician services and procedures)
CSSC Customer Service and Support Center
CWF Common Working File (National file of Medicare claims)
CWFM CWF Maintenance Contractor
DCG Diagnostic Cost Group
DCN Document Control Number (See also ICN - Internal Control Number)
DMEPOS Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
DMERC Durable Medical Equipment Regional Carrier
DNC Data Network Contractor
DOS Date of Service
DRG Diagnosis Related Group
DX Diagnosis
DxGroup Diagnosis Group
EDB Enrollment Database
EDI Electronic Data Interchange
EIN Employer Identification Number
EMC Electronic Media Claim
EOMB Explanation of Medicare Benefits
ERA Electronic Remittance Advice
ESRD End Stage Renal Disease
FFS Fee-for-Service
FI Fiscal Intermediary
FISS Fiscal Intermediary Standard System
FTP File Transfer Protocol
GROUCH GHP Report Output User Communication Help
HCC Hierarchical Coexisting Condition (type of comprehensive risk adjustment model)
HCFA Health Care Financing Administration (now called CMS)
HCFA 1450 (Also called UB-92) - Medicare Part A claim filing form/ form used for Inpatient AND Outpatient Encounter Coding
HCFA 1500 Medicare Part B claim filing form/ form used for Physician Encounter Coding
HCIS HCFA Customer Information System
HCPCS HCFA Common Procedure Coding System (Uses three levels of codes: CPT-4, alphanumeric, and local codes)
HDC HCFA Data Center
HEDIS Health Employer Data and Information Set (A standard measure of quality of care)
HHA Home Health Agency
HICN Health Insurance Claim Number
HIPAA Health Insurance Portability and Accountability Act
H number Identification number (contract number) for Medicare+Choice Organizations
HPMS Health Plan Management System
HPSA Health Professional Shortage
ICD-9-CM International Classification of Diseases - 9th Edition - Clinical Modification (for coding diagnoses)
ICN Internal Code Number (See also DCN - Document Control Number)
IGS IBM Global Service
INFOMAN CWF Information Management System
Intermediary Company through whom Medicare Part A Claims are sent to HCFA
IP Internet Protocol
JCL Job Control Language
LMRPS Local Medical Review Policies
MBR Master Beneficiary Record
M+C Medicare + Choice
M+C NSF Medicare + Choice National Standard Format
M+CO Medicare + Choice Organization
MCCOY Managed Care Option Information System (Used to view beneficiary information)
MCO Managed Care Organization
MCS Multi Carrier System (Medicare Part B standard claims processing system)
MDC Major Diagnostic Category
MDCN Medicare Data Communications Network
MDS Minimum Data Set
MED Medicare Exclusion Database
MedPAC Medical Payment Advisory Commission
MPFSDB Medicare Physician Fee Schedule Database
MR Medical Review
MSN Medicare Summary Notice
MSP Medicare Secondary Payer
NCH National Claims History
NDM Network Data Mover
NOC Not Otherwise Classified
NPI National Provider Identifier
NSF National Standard Format
OCE Outpatient Code Editor
OIG Office of the Inspector General [HHS]
OMB Office of Management and Budget
OPL Operational Policy Letter
OSCAR Online Survey and Certification Reporting System
Palmetto GBA Palmetto Government Benefits Administrators
PACE Program of All-Inclusive Care for the Elderly
PFFS Private Fee-for-Service Plan
Physician For encounter processing, any eligible individual who provides clinical services (including non physician practitioners and other suppliers)
PIP-DCG Principal Inpatient Diagnostic Cost Group
POS Place of Service or Point of Service
PPS Prospective Payment System
PRO Professional Review Organization; Peer Review Organization
QISMC Quality Improvement System for Managed Care
RA Remittance Advice
RO Regional Office
RTP Return to Provider/Plan
SMI Supplementary Medical Insurance (Part B)
SNF Skilled Nursing Facility
TCP/IP Transmission Control Protocol/Internet Protocol
TOS Type of Service
TPA Third Party Administrator
UB-92 (Also called HCFA 1450 Form) HCFA Medicare Part A Form/Form used for Hospital Inpatient AND Outpatient Encounter Data filing
UPIN Unique Physician Identification Number
UR Utilization Review
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