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Medicare Acronyms & Abbreviations
Please visit our Medicare Glossary for a listing of Medicare terms and definitions.
A | B | C | D | E | F | G | H | I | J | L |
M | N | O | P | Q | R | S | T | U | V | W | Y
A
A Assigned (claim)
AA Anesthesia Assistant
AARP American Association of Retired Persons
ABN Advance Beneficiary Notice
ACE Aetna Claim Exchange (EMC software)
ADA American Dental Association
AECHO Aetna Electronic Claim Home Office (EMC software)
ALJ Administrative Law Judge
AMA American Medical Association
ANSI American National Standards Institute
ARU Audio Response Unit
ASA American Society of Anesthesiologists
ASC Ambulatory Surgery Center
AWP Average Wholesale Price
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B
BAC Beneficiary Advisory Committee
BENE Medicare Beneficiary
BI Benefit Integrity Department
BPO Bureau of Program Operations (HCFA)
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C
CAC Contractor Advisory Committee
CCI Correct Coding Initiative
CCN Claim Control Number
CF Conversion Factor
CFR Code of Federal Regulations
CIM Coverage Issues Manual
CLCCP Comprehensive Limiting Charge Compliance Program
CLIA Clinical Lab Improvement Act
CMD Carrier Medical Director
CMHC Community Mental Health Center
CMN Certificate of Medical Necessity
CMR Comprehensive Medical Review
CNM Certified Nurse Midwife
CNS Clinical Nurse Specialist
CO Central Office (HCFA, in Baltimore, MD)
COB Coordination of Benefits
COBRA Consolidation Omnibus Budget Reconciliation Act of 1986
CP Clinical Psychologist
CPO Care Plan Oversight
CPR Customary, Prevailing, and Reasonable
CPT (CPT4) Current Procedural Terminology, 4th edition (© AMA)
CPT Claims Processing Timeliness
CRD Chronic Renal Disease
CRNA Certified Registered Nurse Anesthetist
CS Customer Service Department
CSW Clinical Social Worker
CWF Common Working File
CY Calendar Year
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D
DDS Doctor of Dental Surgery
DEDUCT Deductible
DEFRA Deficit Reduction Act
DHHS Department of Health and Human Services
DMD Doctor of Medical Dentistry
DME Durable Medical Equipment
DMEPOS Durable Medical Equipment, Prosthetics, Orthotics and Supplies
DMERC Durable Medical Equipment Regional Carrier
DO Doctor of Osteopathy
DOB Date of Birth
DOR Date of Receipt
DOS Date of Service
DPM Doctor of Podiatric Medicine
DRG Diagnosis Related Group
DX Diagnosis
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E
E & M Evaluation and Management Procedure Codes
ECG Electrocardiogram
ECS Electronic Claims Services
EDI Electronic Data Interchange
EFT Electronic Funds Transfer
EGHP Employer Group Health Plans
EI Economic Index
EIN Employer Identification Number
EKG Electrocardiogram
EMC Electronic Media Claim
EOB Explanation of Benefits
EOMB Explanation of Medicare Benefits
ESRD End Stage Renal Disease
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F
FDA Food and Drug Administration
FI Fiscal Intermediaries
FOI Freedom of Information
FOIA Freedom of Information Act
FRC Federal Records Center
FSY Fee Screen Year
FTB First Time Beneficiary (MSP)
FY Fiscal Year (Medicare operates on a fiscal year of October 1 to September 30)
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G
GEHA Government Employees Hospital Association
GPCI Geographic Practice Cost Index
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H
HBP Hospital Based Physician
HCFA Health Care Financing Administration
HCFA-1500 Health Insurance Claim Form
HCFA-192 Medicare Supplier Number Application Form
HCPCS HCFA Common Procedure Coding System
HHA Home Health Agency
HHS Health and Human Services
HICN Health Insurance Claim Number
HIMR Health Insurance Master Record
HME Home Medical Equipment
HMO Health Maintenance Organization
HO Hearing Officer
HPSA Health Professional Shortage Area
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I
ICD-9-CM International Classification of Diseases, Clinical Modification, 9th Revision
ICN Internal Control Number (Medicare’s claim number)
ICU Intensive Care Unit
IDTF Independent Diagnostic Testing Facility
IIC Inflation Index Charge - Customary
IIP Inflation Index Charge - Prevailing
IL Independent Lab
IPL Independent Physiology Lab
IRS Internal Revenue Service
IV Intravenous
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J
J Codes Level 2 HCPCS codes for injectables/drugs
JCAHO Joint Commission Accreditation of Healthcare Organizations
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L
LCER Limiting Charge Exception Report
LCL Lowest Charge Level
LGHP Large Group Health Plan
LFS Lab Fee Schedule
LLP Limited License Practitioner
LPN Licensed Practical Nurse
LVN Licensed Vocational Nurse
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M
MAAC Maximum Allowable Actual Charge
MAC Monitored Anesthesia Care
MCM Medicare Carrier's Manual
MD Doctor of Medicine
MD Medical Director
MEDPARD Medicare Participating Physician/Supplier Directory
MEI Medicare Economic Index
MFAIC Medicare Fraud and Abuse Information Coordinator
MFS Medicare Fee Schedule
MFSDB Medicare Fee Schedule Data Base
MIA Medicare Inpatient Adjudication
MOA Medicare Outpatient Adjudication
MPFSDB Medicare Physician’s Fee Schedule Data Base
MR Medical Review
MSA Medicare Savings Account
MSA Metropolitan Statistical Area
MSN Medicare Summary Notice
MSP Medicare Secondary Payer
MTD Month-to-Date
MVPS Medicare Volume Performance Standard
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N
NA Non-assigned (claim)
NDC National Drug Code
NF Nursing Facility
NH Nursing Home
NM Nurse Midwife
NOBA Notice of Budget Authority
NOC Not Otherwise Classified
NON-MSA Non-Metropolitan Statistical Area
NON-PAR Non-Participating Provider
NOS Number of Service(s)
NP Nurse Practitioner
NSC National Supplier Clearinghouse
NSF National Standard Format
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O
O/EE Individual Owner/Managing Employee
OBRA Omnibus Budget Reconciliation Act
OCR Optical Claim Recognition
OD Optometrist (Doctor of Optometry)
OI Office of Investigations
OIFO Office of Investigations Field Office
OIG Office of the Inspector General
OP Ordering Physician
OT Occupational Therapist
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P
PA Prior Authorization
PA Physician Assistant
PAR Participating in the Medicare Program
PC Professional Component
PDT Purchased Diagnostic Test
PEN Parenteral and Enteral Nutrition
PHS Public Health Service
PIN Provider Identification Number
POL Physician Office Lab
POS Place of Service
PPO Preferred Provider Organization
PPR Physician Payment Reform
PPRC Physician Payment Review Commission
PPS Prospective Payment System
PR Professional Relations Department
PRO Peer Review Organization
PSYCH Psychiatric Services
PT Physical Therapy
PT Patient
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Q
QAP Quality Assurance Program
QC Quality Control
QMB Qualified Medicare Beneficiary
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R
R/C Reasonable Charge
RA Remittance Advice
RBRVS Resource Based Relative Value System
RC Reason Code
REMIT Remittance Advice
REP PAYEE Representative Payee
RHC Rural Health Clinic
RHHIs Regional Home Health Intermediaries
RN Registered Nurse
RO Regional Office (HCFA)
RPT Registered Physical Therapist
RRB Railroad Retirement Benefits
RVS Relative Value Scale
RVU Relative Value Unit
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S
S & I Supervision and Interpretation
SIIS Supplemental Insurance Interface System (crossover claims)
SLMB Specified Lower Income Medicare Beneficiary
SMI Supplemental Medical Insurance
SNF Skilled Nursing Facility
SOI Statement of Intent
SOS Site of Service
SPEC Provider Specialty
SSA Social Security Administration
SSN Social Security Number
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T
TAT Turn-around-time
TC Technical Component of a Diagnostic Test
TCU Transitional Care Unit
TEFRA Tax Equity and Fiscal Responsibility Act of 1983
TIN Taxpayer Identification Number
TMJ Temporomandibular Joint Dysfunction
TOS Type of Service
TPA Third Party Administrator
TPP Third Party Payer
TS Technical Support Department
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U
UPIN Unique Provider Identification Number
UR Utilization Review
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V
VA Veterans’ Administration
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W
WC Workers Compensation Employer Identification Number (EIN). Also referred to as a Tax ID Number.
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Y
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