Cost-Based, Charge-Based, and Contractual Payment Systems

129

List of Acronyms

e following is a list of the more common acronyms that are used in connection with healthcare

payment systems. New acronyms and terminology seem to arise almost every day. Note that addi-

tional references may be made such as specic sections of the Code of Federal Regulations.

837-I electronic version of UB-04 claim form

837-P electronic version of 1500 claim form

1500 professional claim form (see CMS-1500)

6σ Six Sigma (a quality improvement technique)

AA anesthesia assistant

ABC Activity-Based Costing

ABN Advance Beneficiary Notice (see also HINNC,

NONC)

ACA Affordable Care Act (2010)

ACC ambulatory care center

ACEP American College of Emergency Physicians

ACHE American College of Healthcare Executives

ACO accountable care organization

ACS ambulatory care services

ADA Americans with Disabilities Act

AFS Ambulance Fee Schedule

AGPAM American Guild of Patient Account Managers

AHA American Hospital Association

AHIMA American Health Information Management

Association

AHRQ Agency for Healthcare Research and Quality

130  ◾  List of Acronyms

AIRR all-inclusive reimbursement rate

ALJ administrative law judge

ALOS average length of stay

AMA American Medical Association or American

Management Association

AMC Apex Medical Center or Acme Medical Clinic

(fictitious entities)

AO advisory opinion

AOAA American Osteopathic Association Accreditation

A/P accounts payable

APC Ambulatory Payment Classification(s)

AP-DRG All Patient DRG

APG ambulatory patient group

APR-DRG All Patient Refined DRG

A/R accounts receivable

ASCII American Standard Code for Information

Interchange

ASF ambulatory surgical facility

ASP average sales price

AVG ambulatory visit group

AWP average wholesale price

BBA Balanced Budget Act (of 1997)

BBRA Balanced Budget Refinement Act (of 1999)

BIPA Beneficiary Improvement and Protection Act

(of 2000)

BPR business process reengineering

CA-DRG Consolidated Severity-Adjusted DRG

CAP capitated ambulatory plan

CBA cost-benefit analysis

CBR coding, billing, and reimbursement

CBRCO CBR compliance officer

CC (Computer) carbon copy

List of Acronyms  ◾  131

CC coding clinic

CCI Correct Coding Initiative

CCO chief compliance officer

CCR cost-to-charge ratio

CCs complications and comorbidities

CCU critical care unit

CDM charge description master (see generic term

chargemaster)

CENT certified enterostomal nurse therapist

CERT comprehensive error rate testing

CEU continuing education unit

CF conversion factor

CFO chief financial officer

CfP condition for payment (see 42 CFR §424)

CFR Code of Federal Regulations

CHAMPUS Civilian Health and Medical Program of the

Uniformed Services

CHAMPVA Civilian Health and Medical Program of the

Veterans Administration

CHC community health center

CHCP coordinated home health program

CHF congestive heart failure

CIA corporate integrity agreement

CIO chief information officer

CIS computer information system

CM charge master

CMI Case Mix Index

CMP competitive medical plan

CMS Center for Medicare and Medicaid Services

CMS-855 form used to gain billing privileges for Medicare

CMS-1450 UB-04 claim form as used by Medicare

CMS-1500 1500 claim form as used by Medicare

132  ◾  List of Acronyms

CMS-2552 hospital cost report form

CNM certified nurse midwife

CNP certified nurse practitioner

CNS clinical nurse specialist

COB coordination of benefits

CON certificate of need

COO chief operating officer

CoP condition of participation (see 42 CFR §482)

CP clinical psychologist

CPI consumer price index

CPI-U consumer price index–urban

CPT Current Procedural Terminology (Currently CPT-4;

anticipated to go to CPT-5)

CQI continuous quality improvement

CRNA certified registered nurse anesthetist

CSF critical success factor

CSW clinical social worker

CT computer tomography

CWF common working file

DBMS database management system

DEA Drug Enforcement Administration

DED dedicated emergency department (see EMTALA)

DHHS Department of Health and Human Services

DME durable medical equipment

DMEPOS DME, prosthetics, orthotics, supplies

DMERC durable medical equipment regional carrier

(see CMS MACs)

DNS Domain Name System (Internet)

DO doctor of osteopathy

DOD Department of Defense

DOJ Department of Justice

DP data processing

List of Acronyms  ◾  133

DRA Deficit Reduction Act (of 2005)

DRG Diagnosis Related Group (see AP-DRG, APR-DRG,

CA-DRG, MS-DRG, SR-DRG)

DSH disproportionate share hospital

DSMT diabetic self-management training

E/M evaluation and management

EBCDIC

(Computer)

Extended Binary Coded Decimal Information Code

ECG electrocardiogram

ED emergency department

EDI electronic data interchange

EEO Equal Employment Opportunity

EEOC Equal Employment Opportunity Commission

EGHP employer group health plan

EKG See ECG. German for elektrokardiogramm

E/M evaluation and management

EMC electronic medical claim

EMI Encounter Mix Index

EMG electromyography

EMTALA Emergency Medical Treatment and Active Labor Act

EOB explanation of benefits

EOMB explanation of Medicare benefits

EPA Environmental Protection Agency

EPC event-driven process chain

EPO exclusive provider organization

ER emergency room (see also emergency department)

ERISA Employment Retirement Income Security Act

ESRD end-stage renal disease

FAC freestanding ambulatory care

FAQ frequently asked question

FBI Federal Bureau of Investigation

FDA Food and Drug Administration