Medfile Tip of The Day

MedFile Tips and Tricks

 

It's easy to locate the Patient record you want by using Find (CNTRL+F), but did you know that you can also use Find to easily locate Patients who have a high account balance?  Or all Claims for any Patient, entries in the Procedures list that you want to change, or just about anything else anywhere in MedFile.  Life always gets easier when you learn more about Find.  Check the Help Menu!

Medical Billing Glossary Terms 4

Scrubbing - Process of checking an insurance claim for errors in the health insurance claim software prior to submitting to the payer.
Self-Referral - When a patient sees a specialist without a primary physician referral.
Self Pay - Payment made at the time of service by the patient.
Secondary Insurance Claim - claim for insurance coverage paid after the primary insurance makes payment. Secondary insurance is typically used to cover gaps in insurance coverage.
Secondary Procedure - When a second CPT procedure is performed during the same physician visit as the primary procedure.
Security Standard - Provides guidance for developing and implementing policies and procedures to guard and mitigate compromises to security. The HIPAA security standard is kind of a sub-set or compliment to the HIPAA privacy standard. Where the HIPAA policy privacy requirements apply to all patient Protected Health Information (PHI), HIPAA policy security laws apply more specifically to electronic PHI.
Skilled Nursing Facility - A nursing home or facility for convalescence. Provides a high level of specialized care for long-term or acutely ill patients. A Skilled Nursing Facility is an alternative to an extended hospital stay or home nursing care.
SOF - Signature on File.
Software As A Service (SAAS) - One of the medical billing terms for a software application that is hosted on a server and accessible over the Internet. SAAS relieves the user of software maintenance and support and the need to install and run an application on an individual local PC or server. Many medical billing applications are available as SAAS.
Specialist - Pphysician who specializes in a specific area of medicine, such as urology, cardiology, orthopedics, oncology, etc. Some heathcare plans require beneficiaries to obtain a referral from their primary care doctor before making an appointment to see a Specialist.

Glossary of Billing Terms

Subscriber - Medical billing term to describe the employee for group policies. For individual policies the subscriber describes the policyholder.

Superbill - One of the medical billing terms for the form the provider uses to document the treatment and diagnosis for a patient visit. Typically includes several commonly used ICD-9 diagnosis and CPT procedural codes. One of the most frequently used medical billing terms.
Supplemental Insurance - Additional insurance policy that covers claims fro deductibles and coinsurance. Frequently used to cover these expenses not covered by Medicare.
TAR - Treatment Authorization Request. An authorization number given by insurance companies prior to treatment in order to receive payment for services rendered.
Taxonomy Code - Specialty standard codes used to indicate a providers specialty sometimes required to process a claim.
Term Date - Date the insurance contract expired or the date a subscriber or dependent ceases to be eligible.
Tertiary Insurance Claim - Claim for insurance coverage paid in addition to primary and secondary insurance. Tertiary insurance covers gaps in coverage the primary and secondary insurance may not cover.
Third Party Administrator (TPA) - An independent corporate entity or person (third party) who administers group benefits, claims and administration for a self-insured company or group.
TIN - Tax Identification Number. Also known as Employer Identification Number (EIN).
TOP - Triple Option Plan. An insurance plan which offers the enrolled a choice of a more traditional plan, an HMO, or a PPO. This is also commonly referred to as a cafeteria plan.
TOS - Type of Service. Description of the category of service performed.
TRICARE - This is federal health insurance for active duty military, National Guard and Reserve, retirees, their families, and survivors. Formerly know as CHAMPUS.
UB04 - Claim form for hospitals, clinics, or any provider billing for facility fees similar to CMS 1500. Replaces the UB92 form.

Glossary of Billing Terms

Unbundling - Submitting several CPT treatment codes when only one code is necessary.

Untimely Submission - Medical claim submitted after the time frame allowed by the insurance payer. Claims submitted after this date are denied.
Upcoding - An illegal practice of assigning an ICD-9 diagnosis code that does not agree with the patient records for the purpose of increasing the reimbursement from the insurance payor.
UPIN - Unique Physician Identification Number. 6 digit physician identification number created by CMS. Discontinued in 2007 and replaced by NPI number.
Usual Customary & Reasonable(UCR) - The allowable coverage limits (fee schedule) determined by the patients insurance company to limit the maximum amount they will pay for a given service or item as defined in the contract with the patient.
Utilization Limit - The limits that Medicare sets on how many times certain services can be provided within a year. The patients claim can be denied if the services exceed this limit.
Utilization Review (UR) - Review or audit conducted to reduce unnecessary inpatient or outpatient medical services or procedures.
V-Codes - ICD-9-CM coding classification to identify health care for reasons other than injury or illness.
Workers Comp - Insurance claim that results from a work related injury or illness.
Write-off - Typically reference to the difference between what the physician charges and what the insurance plan contractually allows and the patient is not responsible for. May also be referred to as "not covered" in some glossary of billing terms.

Medical Billing Glossary Terms 3

MAC - Medicare Administrative Contractor.
Managed Care Plan - Insurance plan requiring patient to see doctors and hospitals that are contracted with the managed care insurance company. Medical emergencies or urgent care are exceptions when out of the managed care plan service area.
Maximum Out of Pocket - The maximum amount the insured is responsible for paying for eligible health plan expenses. When this maximum limit is reached, the insurance typically then pays 100% of eligible expenses.
Medical Assistant - A health care worker who performs administrative and clinical duties in support of a licensed health care provider such as a physician, physicians assistant, nurse, nurse practitioner, etc.
Medical Coder - Analyzes patient charts and assigns the appropriate code. These codes are derived from ICD-9 codes (soon to be ICD-10) and corresponding CPT treatment codes and any related CPT modifiers.
Medical Billing Specialist - Processes insurance claims for payment of services performed by a physician or other health care provider. Ensures patient medical billing codes, diagnosis, and insurance information are entered correctly and submitted to insurance payer. Enters insurance payment information and processes patient statements and payments. Performs tasks vital to the financial operation of a practice. Knowledgeable in medical billing terminology.
Medical Necessity - Medical service or procedure that is performed on for treatment of an illness or injury that is not considered investigational, cosmetic, or experimental.
Medical Record Number - A unique number assigned by the provider or health care facility to identify the patient medical record.
MSP - Medicare Secondary Payer.
Medical Savings Account - Tax exempt account for paying medical expenses administered by a third party to reimburse a patient for eligible health care expenses. Typically provided by employer where the employee contributes regularly to the account before taxes and submits claims or receipts for reimbursement. Sometimes also referred to in medical billing terminology as a Medical Spending Account.
Medical Transcription - The conversion of voice recorded or hand written medical information dictated by health care professionals (such as physicians) into text format records. These records can be either electronic or paper.
Medicare - Insurance provided by federal government for people over 65 or people under 65 with certain restrictions. There are 2 parts:

• Medicare Part A - Hospital coverage


• Medicare Part B - Physicians visits and outpatient procedures


• Medicare Part D - Medicare insurance for prescription drug costs for anyone enrolled in Medicare Part A or B.

Medicare Coinsurance Days - Medical billing terminology for inpatient hospital coverage from day 61 to day 90 of a continuous hospitalization. The patient is responsible for paying for part of the costs during those days. After the 90th day, the patient enters "Lifetime Reserve Days."

Medicare Donut Hole - The gap or difference between the initial limits of insurance and the catastrophic Medicare Part D coverage limits for prescription drugs.

Medical Billing Terminology

Medicaid - Insurance coverage for low income patients. Funded by Federal and state government and administered by states.

Medigap - Medicare supplemental health insurance for Medicare beneficiaries which may include payment of Medicare deductibles, co-insurance and balance bills, or other services not covered by Medicare.
Modifier - Modifier to a CPT treatment code that provide additional information to insurance payers for procedures or services that have been altered or "modified" in some way. Modifiers are important to explain additional procedures and obtain reimbursement for them.
N/C - Non-Covered Charge. A procedure not covered by the patients health insurance plan.
NEC - Not Elsewhere Classifiable. Medical billing terminology used in ICD when information needed to code the term in a more specific category is not available.
Network Provider - Health care provider who is contracted with an insurance provider to provide care at a negotiated cost.
Nonparticipation - When a healthcare provider chooses not to accept Medicare-approved payment amounts as payment in full.
NOS - Not Otherwise Specified. Used in ICD for unspecified diagnosis.
NPI Number - National Provider Identifier. A unique 10 digit identification number required by HIPAA and assigned through the National Plan and Provider Enumeration System (NPPES).
OIG - Office of Inspector General - Part of department of Health and Human Services. Establish compliance requirements to combat healthcare fraud and abuse. Has guidelines for billing services and individual and small group physician practices.
Out-of Network (or Non-Participating) - A provider that does not have a contract with the insurance carrier. Patients usually responsible for a greater portion of the charges or may have to pay all the charges for using an out-of network provider.
Out-Of-Pocket Maximum - The maximum amount the patient has to pay under their insurance policy. Anything above this limit is the insurers obligation. These Out-of-pocket maximums can apply to all coverage or to a specific benefit category such as prescriptions.
Outpatient - Typically treatment in a physicians office, clinic, or day surgery facility lasting less than one day.
Palmetto GBA - An administrator of Medicare health insurance for the Centers for Medicare & Medicaid Services (CMS) in the US and its territories. A wholly owned subsidiary of BlueCross BlueShield of South Carolina based in Columbia, South Carolina.



Patient Responsibility - The amount a patient is responsible for paying that is not covered by the insurance plan.
PCP - Primary Care Physician - Usually the physician who provides initial care and coordinates additional care if necessary.
POS - Point-of-Service plan. Medical billing terminology for a flexible type of HMO (Health Maintenance Organization) plan where patients have the freedom to use (or self-refer to) non-HMO network providers. When a non-HMO specialist is seen without referral from the Primary Care Physician (self-referral), they have to pay a higher deductible and a percentage of the coinsurance.
POS (Used on Claims) - Place of Service. Medical billing terminology used on medical insurance claims - such as the CMS 1500 block 24B. A two digit code which defines where the procedure was performed. For example 11 is for the doctors office, 12 is for home, 21 is for inpatient hospital, etc.
PPO - Preferred Provider Organization. Commercial insurance plan where the patient can use any doctor or hospital within the network. Similar to an HMO.
Practice Management Software - software used for the daily operations of a providers office. Typically used for appointment scheduling and billing.
Preauthorization - Requirement of insurance plan for primary care doctor to notify the patient insurance carrier of certain medical procedures (such as outpatient surgery) for those procedures to be considered a covered expense.
Pre-Certification - Sometimes required by the patients insurance company to determine medical necessity for the services proposed or rendered. This doesn't guarantee the benefits will be paid.
Predetermination - Maximum payment insurance will pay towards surgery, consultation, or other medical care - determined before treatment.
Pre-existing Condition (PEC) - A medical condition that has been diagnosed or treated within a certain specified period of time just before the patients effective date of coverage. A Pre-existing condition may not be covered for a determined amount of time as defined in the insurance terms of coverage (typically 6 to 12 months).
Pre-existing Condition Exclusion - When insurance coverage is denied for the insured when a pre-existing medical condition existed when the health plan coverage became effective.
Premium - The amount the insured or their employer pays (usually monthly) to the health insurance company for coverage.
Privacy Rule - The HIPAA privacy standard establishes requirements for disclosing what the HIPAA privacy law calls Protected Health Information (PHI). PHI is any information on a patient about the status of their health, treatment, or payments.
Provider - Physician or medical care facility (hospital) who provides health care services.
PTAN - Provider Transaction Access Number. Also known as the legacy Medicare number.
Referral - When one provider (usually a family doctor) refers a patient to another provider (typically a specialist).
Remittance Advice (R/A) - A document supplied by the insurance payer with information on claims submitted for payment. Contains explanations for rejected or denied claims. Also referred to as an EOB (Explanation of Benefits).
Responsible Party - The person responsible for paying a patients medical bill. Also referred to as the guarantor.
Revenue Code - Medical billing terminology for a 3-digit number used on hospital bills to tell the insurer where the patient was when they received treatment, or what type of item a patient received.
RVU - Relative Value Amount. This is the average amount Medicare will pay a provider or hospital for a procedure (CPT-4). This amount varies depending on geographic location.

Medical Billing Glossary Terms con't

Fee For Service - Insurance where the provider is paid for each service or procedure provided. Typically allows patient to choose provider and hospital. Some policies require the patient to pay provider directly for services and submit a claim to the carrier for reimbursement. The trade-off for this flexibility is usually higher deductibles and co-pays.

Fee Schedule - Cost associated with each treatment CPT medical billing codes.
Financial Responsibility - The portion of the charges that are the responsibility of the patient or insured.
Fiscal Intermediary (FI) - A Medicare representative who processes Medicare claims.
Formulary - A list of prescription drug costs which an insurance company will provide reimbursement for.
Fraud - When a provider receives payment or a patient obtains services by deliberate, dishonest, or misleading means.
GPH - Group Health Plan. A means for one or more employer who provide health benefits or medical care for their employees (or former employees).

Medical Billing Glossary

Group Name - Name of the group or insurance plan that insures the patient.

Group Number - Number assigned by insurance company to identify the group under which a patient is insured.
Guarantor - A responsible party and/or insured party who is not a patient.
HCFA - Health Care Financing Administration. Now know as CMS (see above in Medical Billing Terms).
HCPCS - Health Care Financing Administration Common Procedure Coding System. (pronounced "hick-picks"). Three level system of codes. CPT is Level I. A standardized medical coding system used to describe specific items or services provided when delivering health services. May also be referred to as a procedure code in the medical billing glossary.
The three HCPCS levels are:

• Level I - American Medical Associations Current Procedural Terminology (CPT) codes.
• Level II - The alphanumeric codes which include mostly non-physician items or services such as medical supplies, ambulatory services, prosthesis, etc. These are items and services not covered by CPT (Level I) procedures.
• Level III - Local codes used by state Medicaid organizations, Medicare contractors, and private insurers for specific areas or programs.

Healthcare Insurance - Insurance coverage to cover the cost of medical care necessary as a result of illness or injury. May be an individual policy or family policy which covers the beneficiary's family members. May include coverage for disability or accidental death or dismemberment.

Medical Billing Glossary

Heathcare Provider - Typically a physician, hospital, nursing facility, or laboratory that provides medical care services. Not to be confused with insurance providers or the organization that provides insurance coverage.

Health Care Reform Act - Health care legislation championed by President Obama in 2010 to provide improved individual health care insurance or national health care insurance for Americans. Also referred to as the Health Care Reform Bill or the Obama Health Care Plan.
HIC - Health Insurance Claim. This is a number assigned by the the Social Security Administration to a person to identify them as a Medicare beneficiary. This unique number is used when processing Medicare claims.
HIPAA - Health Insurance Portability and Accountability Act. Several federal regulations intended to improve the efficiency and effectiveness of health care and establish privacy and security laws for medical records. HIPAA has introduced a lot of new medical billing terms into our vocabulary lately.
HMO - Health Maintenance Organization. A type of health care plan that places restrictions on treatments.
Hospice - Inpatient, outpatient, or home healthcare for terminally ill patients.
ICD-9 Code - Also know as ICD-9-CM. International Classification of Diseases classification system used to assign codes to patient diagnosis. This is a 3 to 5 digit number.
ICD 10 Code - 10th revision of the International Classification of Diseases. Uses 3 to 7 digit. Includes additional digits to allow more available codes. The U.S. Department of Health and Human Services has set an implementation deadline of October, 2013 for ICD-10.
Incremental Nursing Charge - Charges for hospital nursing services in addition to basic room and board.
Indemnity - Also referred to as fee-for-service. This is a type of commercial insurance were the patient can use any provider or hospital
In-Network (or Participating) - An insurance plan in which a provider signs a contract to participate in. The provider agrees to accept a discounted rate for procedures.
Inpatient - Hospital stay of more than one day (24 hours).
IPA - Independent Practice Association. An organization of physicians that are contracted with a HMO plan.
Intensive Care - Hospital care unit providing care for patients who need more than the typical general medical or surgical area of the hospital can provide. May be extremely ill or seriously injured and require closer observation and/or frequent medical attention.

Medical Billing Glossary Terms

F thru K L thru R S thru Z


AMA - American Medical Association. The AMA is the largest association of doctors in the United States. They publish the Journal of American Medical Association which is one of the most widely circulated medical journals in the world.

Aging - One of the medical billing terms referring to the unpaid insurance claims or patient balances that are due past 30 days. Most medical billing software's have the ability to generate a separate report for insurance aging and patient aging. These reports typically list balances by 30, 60, 90, and 120 day increments.
Ancillary Services - These are typically services a patient requires in a hospital setting that are in addition to room and board accommodations - such as surgery, tests, counseling, therapy, etc.
Appeal - When an insurance plan does not pay for treatment, an appeal (either by the provider or patient) is the process of objecting this decision. The insurer may require documentation when processing an appeal and typically has a formal policy or process established for submitting an appeal. Many times the process and associated forms can be found on the insurance providers web site.
Applied to Deductible - You typically see these medical billing terms on the patient statement. This is the amount of the charges, determined by the patients insurance plan, the patient owes the provider. Many plans have a maximum annual deductible that once met is then covered by the insurance provider.
Assignment of Benefits - Insurance payments that are paid to the doctor or hospital for a patients treatment.
ASP - Application Service Provider. This is a computer based services over a network for a particular application. Sometimes referred to as SaaS (Software as a Service). There application service providers that offer Medical Billing. The appeal of an ASP is it frees a business of the the need to purchase, maintain, and backup software and servers.
Beneficiary - Person or persons covered by the health insurance plan.

Medical Billing Terms - Medical Billing Glossary

Blue Cross Blue Shield (BCBS) - An organization of affiliated insurance companies (approximately 450), independent of the association (and each other), that offer insurance plans within local regions under one or both of the association's brands (Blue Cross or Blue Shield). Many local BCBS associations are non-profit BCBS sometimes acts as administrators of Medicare in many states or regions.

Capitation - A fixed payment paid per patient enrolled over a defined period of time, paid to a health plan or provider. This covers the costs associated with the patients health care services. This payment is not affected by the type or number of services provided.
CHAMPUS - Civilian Health and Medical Program of the Uniformed Services. Recently renamed TRICARE. This is federal health insurance for active duty military, National Guard and Reserve, retirees, their families, and survivors.
Charity Care - When medical care is provided at no cost or at reduced cost to a patient that cannot afford to pay.
Clean Claim - Medical billing term for a complete submitted insurance claim that has all the necessary correct information without any omissions or mistakes that allows it to be processed and paid promptly.
Clearinghouse - This is a service that transmits claims to insurance carriers. Prior to submitting claims the clearinghouse scrubs claims and checks for errors. This minimizes the amount of rejected claims as most errors can be easily corrected. Clearinghouses electronically transmit claim information that is compliant with the strict HIPPA standards (this is one of the medical billing terms we see a lot more of lately).
CMS - Centers for Medicaid and Medicare Services. Federal agency which administers Medicare, Medicaid, HIPPA, and other health programs. Formerly known as the HCFA (Health Care Financing Administration). You'll notice that CMS it the source of a lot of medical billing terms.
CMS 1500 - Medical claim form established by CMS to submit paper claims to Medicare and Medicaid. Most commercial insurance carriers also require paper claims be submitted on CMS-1500's. The form is distinguished by it's red ink.
Coding - Medical Billing Coding involves taking the doctors notes from a patient visit and translating them into the proper ICD-9 code for diagnosis and CPT medical billing codes for treatment.
COBRA Insurance - This is health insurance coverage available to an individual and their dependents after becoming unemployed - either voluntary or involuntary termination of employment for reasons other than gross misconduct. Because it does not typically receive company matching, It's typically more expensive than insurance the cost when employed but does benefit from the savings of being part of a group plan. Employers must extend COBRA coverage to employees dismissed for a. COBRA stands for Consolidated Omnibus Budget Reconciliation Act which was passed by Congress in 1986.
COBRA coverage typically lasts up to 18 months after becoming unemployed and under certain conditions extend up to 36 months.
Co-Insurance - Percentage or amount defined in the insurance plan for which the patient is responsible. Most plans have a ratio of 90/10 or 80/20, 70/30, etc. For example the insurance carrier pays 80% and the patient pays 20%.
Collection Ratio - This is in reference to the providers accounts receivable. It's the ratio of the payments received to the total amount of money owed on the providers accounts.
Contractual Adjustment - The amount of charges a provider or hospital agrees to write off and not charge the patient per the contract terms with the insurance company.
Coordination of Benefits - When a patient is covered by more than one insurance plan. One insurance carrier is designated as the primary carrier and the other as secondary.
Co-Pay - Amount paid by patient at each visit as defined by the insured plan.
CPT Code - Current Procedural Terminology. This is a 5 digit code assigned for reporting a procedure performed by the physician. The CPT has a corresponding ICD-9 diagnosis code. Established by the American Medical Association. This is one of the medical billing terms we use a lot.
Credentialing - This is an application process for a provider to participate with an insurance carrier. Many carriers now request credentialing through CAQH. CAQH credentialing process is a universal system now accepted by insurance company networks.
Credit Balance - The balance thats shown in the "Balance" or "Amount Due" column of your account statement with a minus sign after the amount (for example $50-). It may also be shown in parenthesis; ($50). The provider may owe the patient a refund.
Crossover claim - When claim information is automatically sent from Medicare the secondary insurance such as Medicaid.
Date of Service (DOS) - Date that health care services were provided.
Day Sheet - Summary of daily patient treatments, charges, and payments received.
Deductible - amount patient must pay before insurance coverage begins. For example, a patient could have a $1000 deductible per year before their health insurance will begin paying. This could take several doctor's visits or prescriptions to reach the deductible.
Demographics - Physical characteristics of a patient such as age, sex, address, etc. necessary for filing a claim.
DME - Durable Medical Equipment - Medical supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.
DOB - Abbreviation for Date of Birth
Downcoding - When the insurance company reduces the code (and corresponding amount) of a claim when there is no documentation to support the level of service submitted by the provider. The insurers computer processing system converts the code submitted down to the closest code in use which usually reduces the payment.
Duplicate Coverage Inquiry (DCI) - Request by an insurance company or group medical plan by another insurance company or medical plan to determine if other coverage exists.
Dx - Abbreviation for diagnosis code (ICD-9 or ICD-10 code).
Electronic Claim - Claim information is sent electronically from the billing software to the clearinghouse or directly to the insurance carrier. The claim file must be in a standard electronic format as defined by the receiver.
Electronic Funds Transfer (EFT) - An electronic paperless means of transferring money. This allows funds to be transferred, credited, or debited to a bank account and eliminates the need for paper checks.
E/M - Evaluation and Management section of the CPT codes. These are the CPT codes 99201 thru 99499 most used by physicians to access (or evaluate) a patients treatment needs.
EMR - Electronic Medical Records. Also referred to as EHR (Electronic Health Records). This is a medical record in digital format of a patients hospital or provider treatment. An EMR is the patient's medical record managed at the providers location. The EHR is a comprehensive collection of the patients medical records created and stored at several locations.
Enrollee - Individual covered by health insurance.
EOB - Explanation of Benefits. One of the medical billing terms for the statement that comes with the insurance company payment to the provider explaining payment details, covered charges, write offs, and patient responsibilities and deductibles.
ERA - Electronic Remittance Advice. This is an electronic version of an insurance EOB that provides details of insurance claim payments. These are formatted in according to the HIPAA X12N 835 standard.
ERISA - Employee Retirement Income Security Act of 1974. This law established the reporting, disclosure of grievances, and appeals requirements and financial standards for group life and health. Self-insured plans are regulated by this law

Medical Terms

ablation
abstract abuse access accessibility of services accessory dwelling unit (adu) accreditation accreditation cycle for m-c deeming accreditation for deeming accreditation for participation accredited (accreditation) accredited standards committee act, law, statute activities of daily living (adl) actual charge actuarial balance actuarial deficit actuarial rates actuarial soundness actuarial status acupuncture acute add-on-code additional benefits adjusted average per capita cost (aapcc) adjusted community rating (acr) administrative code sets administrative costs administrative data administrative expenses administrative law judge (alj) administrative services only administrative simplification administrative simplification compliance act administrator admission date admitting diagnosis code admitting physician adult living care facility advanced contract billing codes(abc codes) advance beneficiary notice (abn) advance coverage decision advance directives advance directive (health care) adverse effects advisory council on social security advocate affiliated contractor affiliated provider aged enrollee albumin algorithm allowed charge ambulance (air or water) ambulance (land) ambulatory ambulatory care ambulatory care sensitive conditions ambulatory surgical center AMENDMENTS AND CORRECTIONS AMERICAN ASSOCIATION FOR HOMECARE AMERICAN DENTAL ASSOCIATION AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION AMERICAN HOSPITAL ASSOCIATION AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS AMERICAN MEDICAL ASSOCIATION AMERICAN MEDICAL INFORMATICS ASSOCIATION AMERICAN NATIONAL STANDARDS AMERICAN NATIONAL STANDARDS INSTITUTE AMERICAN SOCIETY FOR TESTING AND MATERIALS AMNIOCENTESIS AMORTIZATION AMPUTATION ANALGESIC ANASTOMOSIS ANCILLARY SERVICES ANEMIA ANESTHESIA ANGIODYSPLASIA ANNUAL ELECTION PERIOD ANTIBODY (AB) antigen (ag) appeal appeal process APPROVED AMOUNT ARCTATION (COARCTATION) AREA AGENCY ON AGING (AAA) ARTERY ARTHROCENTESIS ARTHRODESIS ARTHROPLASTY ASPHYXIA aspiration assessment assets assigned claim assignment assisted living association for electronic health care transactions assumptions attachment(s) attending physician authoritative approval authoritative evidence authorization automated claim review average market yield

B BABY BOOM BALANCE BILLING BASE ESTIMATE BASIC BENEFITS BASIC BENEFITS (MEDIGAP POLICY) BENCHMARK BENEFICIARY BENEFICIARY ENCRYPTED FILE BENEFICIARY NOTIFICATION LETTER BENEFITS BENEFITS DESCRIPTION (PLAN) BENEFIT PAYMENTS BENEFIT PERIOD BIOLOGICALS BIOMETRIC IDENTIFIER BIRTHING CENTER BLOOD UREA NITROGEN BLUE CROSS AND BLUE SHIELD ASSOCIATION BOARD-CERTIFIED BOARD AND CARE HOME BOARD HEARING BOARD OF TRUSTEES BODY RECORD BOND BONUS BUSINESS ASSOCIATE BUSINESS MODEL BUSINESS PARTNER BUSINESS RELATIONSHIPS

C CADAVERIC TRANSPLANT CALLABLE CAPITATION CAPPED RENTAL ITEM CAREGIVER CARE PLAN CARRIER CASE MANAGEMENT CASE MANAGER CASE MIX CASE MIX INDEX CASH BASIS CATASTROPHIC ILLNESS CATASTROPHIC LIMIT CENTERS FOR DISEASE CONTROL AND PREVENTION CENTER FOR HEALTHCARE INFORMATION MANAGEMENT CERTIFICATE OF INDEBTEDNESS CERTIFICATE OF MEDICAL NECESSITY CERTIFIED (CERTIFICATION) CERTIFIED NURSING ASSISTANT (CNA) CERTIFIED REGISTERED NURSE ANESTHETIST CHAIN OF TRUST CHAIN OF TRUST AGREEMENT CHRONIC MAINTENANCE DIALYSIS CIVILIAN HEALTH AND MEDICAL PROGRAM (CHAMPUS) CLAIM CLAIM ADJUSTMENT REASON CODES CLAIM ATTACHMENT CLAIM STATUS CATEGORY CODES CLAIM STATUS CODES CLINICAL BREAST EXAM CLINICAL PERFORMANCE MEASURE CLINICAL PRACTICE GUIDELINES CLINICAL TRIALS CMS-1450 CMS-1500 CMS AGENT CMS DIRECTED IMPROVEMENT PROCESS CODE OF FEDERAL REGULATIONS CODE SET CODE SET MAINTAINING ORGANIZATION COGNITIVE IMPAIRMENT COHORT COINSURANCE (MEDICARE PRIVATE FEE-FOR-SERVICE PLAN) COINSURANCE (OUTPATIENT PROSPECTIVE PAYMENT SYSTEM) COLLEGE OF HEALTHCARE INFORMATION MANAGEMENT EXECUTIVES COMMENT COMMERCIAL MCO COMMUNITY MENTAL HEALTH CENTER COMPLAINT COMPLAINT (OF FRAUD OR ABUSE) COMPLIANCE DATE COMPREHENSIVE INPATIENT REHABILITATION FACILITY COMPREHENSIVE MCO COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF) COMPUTER-BASED PATIENT RECORD INSTITUTE-HEALTHCARE OPEN SYSTEMS AND TRIALS COMPUTER MATCHING AGREEMENT CONDITIONAL PAYMENT CONFIDENTIALITY CONSENT AND AUTHORIZATION (BASIC RULE) CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) CONSUMER ASSESSMENT OF HEALTH PLANS STUDY (CAHPS) CONSUMER PRICE INDEX CONSUMER SELF-REPORT DATA CONSUMER SURVEY DATA CONTINGENCY CONTINGENCY MARGIN CONTINUATION OF ENROLLMENT CONTINUING CARE RETIREMENT COMMUNITY (CCRC) CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CONTINUOUS CYCLING PERITONEAL DIALYSIS CONTINUOUS QUALITY IMPROVEMENT CONTRACTOR CONTRIBUTIONS CONTRIBUTION BASE COORDINATED CARE PLAN COORDINATION OF BENEFITS COORDINATION PERIOD COST-BASED HEALTH MAINTENANCE ORGANIZATION COST RATE COST REPORT COST SHARING COVERAGE ANALYSIS FOR LABORATORIES (CALS) COVERAGE BASIS COVERAGE ISSUES MANUAL (CIM) COVERED BENEFIT COVERED CHARGES COVERED EARNINGS COVERED EMPLOYMENT COVERED ENTITY COVERED FUNCTION COVERED SERVICES COVERED WORKER CREDITABLE COVERAGE CRITERIA CRITICAL ACCESS HOSPITAL CROSSWALKING CURRENT DENTAL TERMINOLOGY CURRENT PROCEDURAL TERMINOLOGY CUSTODIAL CARE CUSTODIAN

 

D D-CODES DATA CONDITION DATA CONTENT DATA COUNCIL DATA DICTIONARY DATA ELEMENT DATA EXTRACT SYSTEM ACCESS FORM DATA INTERCHANGE STANDARDS ASSOCIATION DATA MAPPING DATA MODEL DATA SUPPORT ACCESS FACILITY ACCESS FORM DATA USE AGREEMENT DATA USE CHECKLIST DATE OF FILING AND DATE OF SUBMISSION DATE OF RECEIPT DEDUCTIBLE (MEDICARE) DEEMED DEEMED STATUS DEEMED WAGE CREDIT DEEMING AUTHORITY DEFICIENCY (NURSING HOME) DEHYDRATION DEMOGRAPHIC ASSUMPTIONS DEMOGRAPHIC DATA DEMONSTRATIONS DENTAL CONTENT COMMITTEE DEPARTMENT OF HEALTH AND HUMAN SERVICES DERIVATIVE FILE DESCRIPTOR DESIGNATED CODE SET DESIGNATED DATA CONTENT COMMITTEE OR DESIGNATED DCC DESIGNATED STANDARD DESIGNATED STANDARD MAINTENANCE ORGANIZATION DETERMINATION DIABETIC DURABLE MEDICAL EQUIPMENT DIAGNOSIS-RELATED GROUPS DIAGNOSIS DIAGNOSIS CODE DIALYSATE DIALYSIS DIALYSIS CENTER (RENAL) DIALYSIS FACILITY (RENAL) DIALYSIS STATION DIETHYLSTILBESTROL (DES) DIGITAL IMAGING AND COMMUNICATIONS IN MEDICINE DIRECT DATA ENTRY DISABILITY DISABILITY INSURANCE DISABLED ENROLLEE DISCHARGE PLANNING DISCLOSURE DISCLOSURE HISTORY DISCOUNT DRUG LIST DISCRETIONARY SPENDING DISENROLL DISPROPORTIONATE SHARE HOSPITAL DOWNCODE DRAFT STANDARD FOR TRIAL USE DRG CODING DRUG TIERS DUAL ELIGIBLES DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT REGIONAL CARRIER (DMERC) DURABLE POWER OF ATTORNEY

E EARNINGS ECONOMIC ASSUMPTIONS ECONOMIC STABILIZATION PROGRAM EDIT EDI TRANSLATOR EFFECTIVE EFFECTIVE DATE EFFICIENT ELDERCARE ELECTION ELECTION PERIODS ELECTRONIC COMMERCE ELECTRONIC DATA INTERCHANGE ELECTRONIC HEALTHCARE NETWORK ACCREDITATION COMMISSION ELECTRONIC MEDIA CLAIMS ELECTRONIC MEDIA QUESTIONNAIRE ELECTRONIC REMITTANCE ADVICE ELIGIBILITY ELIGIBILITY or MEDICARE PART A ELIGIBILITY or MEDICARE PART B EMERGENCY CARE EMERGENCY ROOM (HOSPITAL) EMPLOYEE EMPLOYER EMPLOYER BULLETIN BOARD SERVICE EMPLOYER GROUP HEALTH PLAN (GHP) EMPLOYER IDENTIFIER EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC EMTALA (EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT) ENCOUNTER DATA END-STAGE RENAL DISEASE END-STAGE RENAL DISEASE (ESRD) END-STAGE RENAL DISEASE NETWORK END STAGE RENAL DISEASE TREATMENT FACILITY ENHANCED BENEFITS ENROLL ENROLLEE HOTLINES ENROLLMENT ENROLLMENT - PART A ENROLLMENT FEE ENROLLMENT PERIOD ENTITY ASSETS EPISODE EPISODE OF CARE EQRO ORGANIZATION EQUIVALENCY REVIEW ESRD ELIGIBILITY REQUIREMENTS ESRD FACILITY ESRD NETWORK ESRD NETWORK ORGANIZATION ESRD PATIENT ESRD SERVICES EVIDENCE EVIDENCE OF FUNDING EXCESS CHARGES EXCLUSIONS (MEDICARE) EXPEDITED APPEAL EXPEDITED ORGANIZATION DETERMINATION EXPENDITURE EXPENSE EXTENDED CARE SERVICES EXTERNAL QUALITY REVIEW ORGANIZATION

F FACILITY CHARGE FALSE NEGATIVES FALSE POSITIVES FEDERALLY QUALIFIED HEALTH CENTER FEDERALLY QUALIFIED HEALTH CENTER (FQHC) FEDERAL GENERAL REVENUES FEDERAL INSURANCE CONTRIBUTIONS ACT FEDERAL INSURANCE CONTRIBUTION ACT PAYROLL TAX FEDERAL MANAGERS' FINANCIAL INTEGRITY ACT FEDERAL MEDICAL ASSISTANCE PERCENTAGE FEDERAL REGISTER FEE-FOR-SERVICES FEE-SCREEN YEAR FEE SCHEDULE FINANCIAL DATA FINANCIAL INTERCHANGE FIRST RESPONDER FISCAL INTERMEDIARY FISCAL YEAR FIXED CAPITAL ASSETS FLAT FILE FOCUSED STUDIES FORMAT FORMULARY FORMULARY DRUGS FRAUD FRAUD AND ABUSE FREEDOM OF INFORMATION ACT FREEDOM OF INFORMATION ACT (FOIA) FREE LOOK (MEDIGAP POLICY) FREQUENCY DISTRIBUTION FULLY ACCREDITED FULL CAPITATION FULL CAPITATION (FUL) FULL PSC OR FULL PROGRAM SAFEGUARD CONTRACTOR

 

G GAPFILLING GAPS GATEKEEPER GENERAL ENROLLMENT PERIOD (GEP) GENERAL FUND OF THE TREASURY GENERAL REVENUE GRIEVANCES AND COMPLAINTS GROSS DOMESTIC PRODUCT GROUP HEALTH PLAN GROUP OR NETWORK HMO GUARANTEED ISSUE RIGHTS (ALSO CALLED MEDIGAP PROTECTIONS) GUARANTEED RENEWABLE GUIDELINES

 

H HCFA-1450 HCFA-1500 HEALTHCARE COMMON PROCEDURAL CODING SYSTEM HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION HEALTHCARE PROVIDER TAXONOMY CODES HEALTH CARE CLEARINGHOUSE HEALTH CARE CODE MAINTENANCE COMMITTEE HEALTH CARE FINANCING ADMINISTRATION DATA MA HEALTH CARE PREPAYMENT PLAN HEALTH CARE PROVIDER HEALTH CARE PROVIDER TAXONOMY COMMITTEE HEALTH CARE QUALITY IMPROVEMENT PROGRAM HEALTH EMPLOYER DATA AND INFORMATION SET (HEDIS) HEALTH INFORMATICS STANDARDS BOARD HEALTH INSURANCE ASSOCIATION OF AMERICA HEALTH INSURANCE CLAIMS NUMBER HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 HEALTH INSURING ORGANIZATION HEALTH LEVEL SEVEN HEALTH MAINTENANCE ORGANIZATIONS (HMO) HEALTH PLAN HEARING HEDIS MEASURES FROM ENCOUNTER DATA HEMATOCRIT HEMODIAFILTRATION HEMODIALYSIS HEMODIALYSIS (HD) HEMOFILTRATION HIGH COST ALTERNATIVE HIGH RISK AREA HIPAA DATA DICTIONARY OR HIPAA DD HOME HOMEBOUND HOME AND COMMUNITY-BASED SERVICE WAIVER PROGRAMS (HCBS) HOME HEALTH AGENCY HOME HEALTH CARE HOME PATIENTS HOSPICE HOSPICE CARE HOSPITALIST HOSPITAL ASSUMPTIONS HOSPITAL COINSURANCE HOSPITAL INDEMNITY INSURANCE HOSPITAL INPUT PRICE INDEX HOSPITAL INSURANCE HOSPITAL INSURANCE (PART A) HOSPITAL MARKET BASKET HYBRID ENTITY HYDRATION

 

I ICD, ICD-N-CM, ICD-N-PCS IMMUNOSUPPRESSIVE DRUGS IMPLEMENTATION GUIDE IMPLEMENTATION SPECIFICATION IMPROVEMENT PLAN INAPPROPRIATE UTILIZATION INCIDENCE INCOME RATE INCURRED BASIS INDEPENDENT LABORATORY INDICATOR INFORMATION, COUNSELING, AND ASSISTANCE PROGRAM INFORMATION MODEL INFUSION PUMPS INITIAL (CLAIM) DETERMINATION INITIAL COVERAGE ELECTION PERIOD INITIAL ENROLLMENT PERIOD INITIAL ENROLLMENT QUESTIONNAIRE (IEQ) INPATIENT CARE INPATIENT HOSPITAL INPATIENT HOSPITAL DEDUCTIBLE INPATIENT HOSPITAL SERVICES INPATIENT PSYCHIATRIC FACILITY INSOLVENCY INSURER INTEREST INTERFUND BORROWING INTERMEDIARY INTERMEDIARY HEARING INTERMEDIARY OR PROGRAM SAFEGUARD CONTRACTOR DETERMINATION INTERMEDIATE CARE FACILITY OR MENTALLY RETARDED INTERMEDIATE ENTITIES INTERMITTENT PERITONEAL DIALYSIS INTERNAL CONTROLS INTERNAL REVENUE SERVICE INTERNATIONAL CLASSIFICATION OF DISEASES INTERNATIONAL ORGANIZATION FOR STANDARDIZATION INTERNIST INTER OR INTRA AGENCY AGREEMENT INTRAGOVERNMENTAL ASSETS, LIABILITIES

J J-CODES JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS

 

L LARGE GROUP HEALTH PLAN LETTER OF REQUEST LETTER OF SUPPORT LIABILITY DETERMINATION LIABILITY INSURANCE LICENSED (LICENSURE) LICENSED BY THE STATE AS A RISK-BEARING ENTITY LIFETIME RESERVE DAYS LIFETIME RESERVE DAYS (MEDICARE) LIMITING CHARGE LINE ITEM LIVING DONOR KIDNEY TRANSPLANT LIVING WILLS LMRP ARTICLES LOCAL CODE(S) LOCAL CODES LOCAL COVERAGE DETERMINATION (LCD) LOCAL MEDICAL REVIEW POLICY (LMRP) LOGICAL OBSERVATION IDENTIFIERS, NAMES AND CODES LONG-TERM CARE LONG-TERM CARE INSURANCE LONG-TERM CARE OMBUDSMAN LONGER TERM CARE MINIMUM DATA SET LONG RANGE LOOP LOW COST ALTERNATIVE

 

M MALNUTRITION MAMMOGRAM MANAGED CARE MANAGED CARE ORGANIZATION MANAGED CARE PAYMENT SUSPENSION MANAGED CARE PLAN MANAGED CARE PLAN WITH A POINT OF SERVICE OPTION (POS) MANAGED CARE SYSTEM MANDATORY SPENDING MANDATORY SUPPLEMENTAL BENEFITS MANUAL CLAIM REVIEW MANUAL TRANSMITTALS MARKET BASKET MASS IMMUNIZATION CENTER MATERIAL WEAKNESS MAXIMUM DEFINED DATA SET MAXIMUM ENROLLEE OUT-OF-POCKET COSTS MAXIMUM PLAN BENEFIT COVERAGE MAXIMUM TAXABLE AMOUNT OF ANNUAL EARNINGS MAXIMUM TAX BASE MCO OR PHP STANDARDS MEASUREMENT MEDIATE MEDICAID-ONLY MCO MEDICAID MEDICAID MANAGEMENT INFORMATION SYSTEM MEDICAID MCO MEDICALLY NECESSARY MEDICAL BILLING MEDICAL BILLING AND CODING JOBS MEDICAL CODE SETS MEDICAL CODING MEDICAL INSURANCE (PART B) MEDICAL RECORDS INSTITUTE MEDICAL REVIEW OR UTILIZATION REVIEW MEDICAL UNDERWRITING MEDICARE-APPROVED AMOUNT MEDICARE MEDICARE ADVANTAGE PLAN MEDICARE BENEFITS MEDICARE BENEFITS NOTICE MEDICARE CARRIER MEDICARE CONTRACTOR MEDICARE COORDINATION OF BENEFITS CONTRACTOR MEDICARE COVERAGE MEDICARE COVERAGE ADVISORY COMMITTEE (MCAC) MEDICARE DURABLE MEDICAL EQUIPMENT REGIONAL CARRIER MEDICARE ECONOMIC INDEX MEDICARE HANDBOOK MEDICARE MANAGED CARE PLAN MEDICARE MEDICAL SAVINGS ACCOUNT PLAN (MSA) MEDICARE NATIONAL COVERAGE DETERMINATIONS MANUAL MEDICARE PART A (HOSPITAL INSURANCE) MEDICARE PART A FISCAL INTERMEDIARY MEDICARE PART B (MEDICAL INSURANCE) MEDICARE PART B CARRIER MEDICARE PART B PREMIUM REDUCTION AMOUNT MEDICARE PAYMENT ADVISORY COMMISSION MEDICARE+CHOICE MEDICARE+CHOICE PLAN MEDICARE PREFERRED PROVIDER ORGANIZATION (PPO) PLAN MEDICARE PREMIUM COLLECTION CENTER (MPCC) MEDICARE PRIVATE FEE-FOR-SERVICE PLAN MEDICARE REMITTANCE ADVICE REMARK CODES MEDICARE SAVINGS PROGRAM MEDICARE SAVINGS PROGRAMS MEDICARE SECONDARY PAYER MEDICARE SELECT MEDICARE SUMMARY NOTICE (MSN) MEDICARE SUPPLEMENT INSURANCE MEDICARE TRUST FUNDS MEDIGAP POLICY MEMORANDUM OF UNDERSTANDING MILITARY SERVICE WAGE CREDITS MILITARY TREATMENT FACILITY MINIMUM SCOPE OF DISCLOSURE MODALITY MODIFIED AVERAGE-COST METHOD MODIFY OR MODIFICATION MONITORING MONITORING OF MCO OR PHP STANDARDS MORBIDITY MORBIDITY RATE MORTALITY RATE MULTI-EMPLOYER GROUP HEALTH PLAN MULTI-EMPLOYER PLAN MULTIPLE EMPLOYER PLAN M+C ORGANIZATION (MEDICARE+CHOICE) M+C PLAN

 

N NATIONAL ASSOCIATION OF HEALTH DATA ORGANIZATIONS NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS NATIONAL ASSOCIATION OF STATE MEDICAID DIRECTORS NATIONAL CENTER FOR HEALTH STATISTICS NATIONAL COMMITTEE FOR QUALITY ASSURANCE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS NATIONAL COVERAGE ANALYSES (NCA) NATIONAL COVERAGE DETERMINATIONS (NCDS) NATIONAL COVERAGE POLICY NATIONAL DRUG CODE NATIONAL EMPLOYER ID NATIONAL HEALTH INFORMATION INFRASTRUCTURE NATIONAL IMPROVEMENT PROJECTS NATIONAL MEDIAN CHARGE NATIONAL PATIENT ID NATIONAL PAYER ID NATIONAL PROVIDER FILE NATIONAL PROVIDER IDENTIFIER NATIONAL PROVIDER REGISTRY NATIONAL PROVIDER SYSTEM NATIONAL STANDARD FORMAT NATIONAL STANDARD PER VISIT RATES NATIONAL UNIFORM BILLING COMMITTEE NATIONAL UNIFORM CLAIM COMMITTEE NCPDP BATCH STANDARD NCPDP TELECOMMUNICATION STANDARD NEBULIZERS NEGLECT NETWORK NO-FAULT INSURANCE NON-COVERED SERVICE NON-ENTITY ASSETS NON-FEDERAL AGENCY NON-FORMULARY DRUGS NONCONTRIBUTORY OR DEEMED WAGE CREDITS NONPARTICIPATING PHYSICIAN NORTH CAROLINA HEALTHCARE INFORMATION AND COMMUNICATIONS ALLIANCE NOTICE OF INTENT NOTICE OF PROPOSED RULEMAKING NPLANID NUBC EDI TAG NURSE PRACTITIONER NURSING FACILITY NURSING HOME NUTRITION

O OBLIGATION OCCUPATIONAL THERAPY OFFICE OFFICE FOR CIVIL RIGHTS OFFICE OF MANAGEMENT & BUDGET OFFSET OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE OMBUDSMAN ON-SITE REVIEWS OPEN ENROLLMENT PERIOD OPEN SYSTEM INTERCONNECTION OPTIONAL SUPPLEMENTAL BENEFITS ORGAN ORGANIZATIONAL DETERMINATION ORGAN PROCUREMENT ORGAN PROCUREMENT ORGANIZATION ORIGINAL MEDICARE PLAN OTHER MANAGED CARE ARRANGEMENT OTHER UNLISTED FACILITY OUT-OF-POCKET COSTS OUTCOME OUTCOME AND ASSESSMENT INFORMATION SET OUTCOME DATA OUTCOME INDICATOR OUTLAY OUTLIER OUTPATIENT CARE OUTPATIENT HOSPITAL OUTPATIENT HOSPITAL SERVICES (MEDICARE) OUTPATIENT PROSPECTIVE PAYMENT SYSTEM OUTPATIENT SERVICES OUT OF AREA OUT OF NETWORK BENEFIT OVERPAYMENT ASSESSMENT

P PANEL SIZE PAP TEST PARTIALLY CAPITATED PARTIAL CAPITATION PARTIAL HOSPITALIZATION PARTICIPATING HOSPITALS PARTICIPATING PHYSICIAN OR SUPPLIER PART A (HOSPITAL INSURANCE) PART A (MEDICARE) PART A OF MEDICARE PART A PREMIUM PART B (MEDICAL INSURANCE) PART B (MEDICARE) PART B OF MEDICARE PATIENT ADVOCATE PATIENT LIFTS PATTERN ANALYSIS PAY-AS-YOU-GO FINANCING PAYER PAYERID PAYMENT PAYMENT RATE PAYMENT SAFEGUARDS PAYMENT SUSPENSION PAYROLL TAXES PELVIC EXAM PERCENTILE PERFORMANCE PERFORMANCE ASSESSMENT PERFORMANCE IMPROVEMENT PROJECTS PERFORMANCE MEASURE PERFORMANCE MEASURES PERIODS OF CARE (HOSPICE) PERITONEAL DIALYSIS PERITONEAL DIALYSIS (PD) PERSONAL CARE PHYSICAL THERAPY PHYSICIAN ASSISTANT (PA) PHYSICIAN GROUP PHYSICIAN INCENTIVE PLAN PHYSICIAN SERVICES PLAN ID PLAN OF CARE PLAN SPONSOR POINT-OF-SERVICE (POS) POINT OF SERVICE (POS) POLICY ADVISORY GROUP POSTPAYMENT REVIEW POTENTIAL FRAUD CASE POTENTIAL PAYMENTS POWER OF ATTORNEY PRE-EXISTING CONDITION PREFERRED PROVIDER ORGANIZATION PREFERRED PROVIDER ORGANIZATION (PPO) PREFERRED PROVIDER ORGANIZATION (PPO) PLAN PREMIUM SURCHARGE PREPAID HEALTH PLAN PREPAYMENT REVIEW PRESENT VALUE PREVALENCE PREVENTIVE SERVICES PRICER PRICER OR REPRICER PRIMARY CARE PRIMARY CARE CASE MANAGEMENT PROVIDER PRIMARY CARE DOCTOR PRIMARY CASE MANAGEMENT PRIMARY PAYER PRIVACY ACT OF 1974 PRIVATE CONTRACT PRIVATE FEE-FOR-SERVICE PLAN PROCEDURE PROCESS PROCESS IMPROVEMENT PROCESS INDICATOR PRODUCTIVITY INVESTMENTS PROFILES PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAM MANAGEMENT PROGRAM MANAGEMENT AND MEDICAL INFORMATION SYSTEM PROGRAM SAFEGUARD CONTRACTOR PROJECTION ERROR PROJECT OFFICER PROSPECTIVE PAYMENT SYSTEM PROS AND CONS PROTECTED HEALTH INFORMATION PROVIDER PROVIDER NETWORK PROVIDER SPONSORED ORGANIZATION (PSO) PROVIDER SURVEY DATA PROVIDER TAXONOMY CODES PROXY PSYCHIATRIC FACILITY (PARTIAL HOSPITALIZATION) PSYCHIATRIC RESIDENTIAL TREATMENT CENTER PUBLIC USE FILE PURCHASE ORDER

 

Q QUALIFIED MEDICARE BENEFICIARY (QMB) QUALIFYING INDIVIDUALS (1) (QI-1S) QUALIFYING INDIVIDUALS (2) (QI-2S) QUALITY QUALITY ASSURANCE QUALITY IMPROVEMENT ORGANIZATION QUINQUENNIAL MILITARY SERVICE DETERMINATION AND ADJUSTMENTS

R RAILROAD RETIREMENT RANDOM SAMPLE REAL-WAGE DIFFERENTIAL REASONABLE-COST BASIS REASONABLE COST RECIPIENT RECOUPMENT REFERRAL REFERRAL SERVICES REGENSTRIEF INSTITUTE REGIONAL HOME HEALTH INTERMEDIARY (RHHI) REGIONAL OFFICE REHABILITATION REHABILITATION (AS DISTINGUISHED FROM VOCATIONAL REHABILITATION) REJECT STATUS RENAL TRANSPLANT CENTER REOPENING REPORT CARD REQUESTOR RERELEASE RESEARCH DATA ASSISTANCE CENTER RESEARCH PROTOCOL RESERVE DAYS RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITY RESIDUAL FACTORS RESOURCE-BASED RELATIVE VALUE SCALE RESPITE CARE RESTRAINTS REUSE REVENUE REVENUE CODE REVIEW OF CLAIMS RIGHTS OF INDIVIDUALS RISK-BASED HEALTH MAINTENANCE ORGANIZATION OR COMPETITIVE MEDICAL PLAN RISK ADJUSTMENT ROUTINE USE RURAL HEALTH CLINIC

 

S SANCTIONS SECONDARY PAYER SECOND OPINION SECRETARY SEER - MEDICARE DATABASE SEER PROGRAM SEGMENT SELF-EMPLOYMENT SELF-EMPLOYMENT CONTRIBUTION ACT PAYROLL TAX SELF-INSURED SELF DIALYSIS SEQUESTER SERVICE SERVICE AREA SERVICE AREA (PRIVATE FEE-FOR-SERVICE) SERVICE CATEGORY DEFINITION SHORT RANGE SIDE EFFECT SINGLE DRUG PRICER SKILLED CARE SKILLED NURSING CARE SKILLED NURSING FACILITY SKILLED NURSING FACILITY (SNF) SKILLED NURSING FACILITY CARE SMALL HEALTH PLAN SMI PREMIUM SNF COINSURANCE SOCIAL HEALTH MAINTENANCE ORGANIZATION (SHMO) SOCIAL SECURITY ACT SOCIAL SECURITY ADMINISTRATION SPECIALIST SPECIALTY CONTRACTOR SPECIALTY PLAN SPECIAL ELECTION PERIOD SPECIAL ENROLLMENT PERIOD SPECIAL PUBLIC-DEBT OBLIGATION SPECIFIED DISEASE INSURANCE SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES (SLMB) SPEECH-LANGUAGE THERAPY SPELL OF ILLNESS STAFF ASSISTED DIALYSIS STANDARD CLAIMS PROCESSING SYSTEM STANDARD TRANSACTION STATE CERTIFICATION STATE CHILDRENS HEALTH INSURANCE PROGRAM STATE HEALTH INSURANCE ASSISTANCE PROGRAM STATE INSURANCE DEPARTMENT STATE LAW STATE LICENSURE AGENCY STATE MEDICAL ASSISTANCE OFFICE STATE OR LOCAL PUBLIC HEALTH CLINIC STATE SURVEY STATE SURVEY AGENCY STATE UNIFORM BILLING COMMITTEE STATUS LOCATION STOCHASTIC MODEL STRATEGIC NATIONAL IMPLEMENTATION PROCESS SUBSIDIZED SENIOR HOUSING SUBSTANTIAL FINANCIAL RISK SUMMARIZED COST RATE SUMMARIZED INCOME RATE SUPPLEMENTAL EDIT SOFTWARE SUPPLEMENTARY MEDICAL INSURANCE SUPPLIER SURVEY AND CERTIFICATION PROCESS SUSPENSION OF PAYMENTS SUSTAINABLE GROWTH RATE SYNTAX SYSTEMATIC SYSTEM NOTICE SYSTEM OF RECORDS

 

T TAXABLE EARNINGS TAXABLE PAYROLL TAXABLE SELF-EMPLOYMENT INCOME TAXABLE WAGES TAXATION OF BENEFITS TAXES TAX AND DONATIONS TAX RATE TECHNOLOGY ASSESSMENT (TA) TELEMEDICINE TERM INSURANCE TEST OF LONG-RANGE CLOSE ACTUARIAL BALANCE TEST OF SHORT-RANGE FINANCIAL ADEQUACY THIRD PARTY ADMINISTRATOR THIRD PARTY USE TIER TRADING PARTNER TRANSACTION TRANSACTION CHANGE REQUEST SYSTEM TRANSIENT PATIENTS TRANSPLANT TRAUMA CODE DEVELOPMENT TREATMENT TREATMENT OPTIONS TRICARE TRICARE FOR LIFE (TFL) TRUE NEGATIVES TRUST FUND TRUST FUND RATIO TTY

 

U UB-82 UB-92 UNASSIGNED CLAIM UNIFORM CLAIM TASK FORCE UNITED NATIONS CENTRE FOR FACILITATION OF PROCEDURES AND PRACTICES FOR ADMINISTRATION, COMMERCE, AND UNITED NATIONS RULES FOR ELECTRONIC DATA INTERCHANGE FOR ADMINISTRATION, COMMERCE, AND TRANSPORT UNIT INPUT INTENSITY ALLOWANCE URGENTLY NEEDED CARE UTAH HEALTH INFORMATION NETWORK UTILIZATION SUMMARY DATA

 

V VALIDATION VALUATION PERIOD VALUE-ADDED NETWORK VIRTUAL PRIVATE NETWORK VOCATIONAL REHABILITATION VOLUNTARY AGREEMENT VOLUNTARY ENROLLEE

W WAITING PERIOD WASHINGTON PUBLISHING COMPANY WITHHOLD WORKERS COMPENSATION WORKFORCE WORKGROUP FOR ELECTRONIC DATA INTERCHANGE WORLD HEALTH ORGANIZATION

 

X X12 X12F X12J X12N X12N OR SPTG4 X12N OR TG1 X12N OR TG2 X12N OR TG2 OR WG1 X12N OR TG2 OR WG12 X12N OR TG2 OR WG15 X12N OR TG2 OR WG19 X12N OR TG2 OR WG2 X12N OR TG2 OR WG3 X12N OR TG2 OR WG4 X12N OR TG2 OR WG5 X12N OR TG2 OR WG9 X12N OR TG3 X12N OR TG3 OR WG1 X12N OR TG3 OR WG21 X12N OR TG3 OR WG3 X12N OR TG3 OR WG4 X12N OR TG4 X12N OR TG8 X12N TG2 WG10 X12 148 X12 270 X12 271 X12 274 X12 275 X12 276 X12 277 X12 278 X12 811 X12 820 X12 831 X12 834 X12 835 X12 837 X12 997 X12 IHCEBI & IHCEBR X12 IHCLME X12 OR PRB X12 STANDARD

 

From AAPC