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

Get Cost-Based, Charge-Based, and Contractual Payment Systems now with O’Reilly online learning.

O’Reilly members experience live online training, plus books, videos, and digital content from 200+ publishers.