Abbreviations

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					Acronym     Term
ACP         American College of Physicians
ACR         American College of Radiology
ACRO        American College of Radiation Oncology
AFROC       Association of Freestanding Radiation Oncology Centers
AHA         American Hospital Association
AHRQ        Agency for Healthcare Research and Quality
AMA         American Medical Association
APC         Ambulatory Payment Class
APG         Ambulatory Patient Group
APME        Advisory Panel on Medicare Education
APR - DRG   all payer refined - diagnosis related groups
AQA         Ambulatory Care Quality Alliance
ASTRO       American Society for Therapeutic Radiology & Oncology
AWP         Actual Wholesale Price
BAC         Beneficiary Advisory Committee
BBA         Balanced Budget Act of 1997
BC/BS       Blue Cross/Blue Shield
BCBSA       Blue Cross/Blue Shield Association
BETOS       Berenson Eggers Type of Service
CAC         Carrier Advisory Committee
CAH         Critical Access Hospital
CBO         Congressional Budget Office
CCI         Correct Coding Initiative
CCIP        Chronic Care Improvement Programs
CCR         Cost to Charge Ratio
CDRG        Children's Diagnosis Related Groups
CF          Conversion Factor
CFR         Code of Federal Regulations
CLIA        Clinical Laboratory Improvement Act (of 1965) (Amendments 1988)
CMD         Carrier or Contactor Medical Director
CMI         Case Mix Index
CMS         Centers for Medicare and Medicaid Services
CMSA        Consolidated Metropolitan Statistical Area
COB         Coordination of Benefits
COBRA       Consolidated Omnibus Budget Reconciliation Act (of 1985)
CPI         Consumer Price Index
CPI-PD      Consumer Price Index for Prescription Drugs and Medical Supplies
CPI-U       Consumer Price Index for Urban Areas
CPM         Claims Processing Manual
CPM         Clinical Performance Measure
CPT         Current Procedural Terminology
CPT-4       Current Procedural Terminology, Version 4
CQI      Continuous Quality Improvement
CRS      Congressional Reporting System
CRS      Congressional Research Service
CY       Calendar Year
DCG      Diagnostic Cost Group (Demonstration)
DHHS     Department of Health & Human Services
DME      Durable Medical Equipment
DMEFS    Durable Medical Equipment Fee Schedule
DMEPOS   Durable Medical Equipment Prosthetic, Orthotics & Supplies
DMERC    Durable Medical Equipment Regional Carrier
DRA      Deficit Reduction Act of 1984
DRG      Diagnostic Related Group (patients with similar illness)
DSH      Disproportionate Share Hospital
DSM      Diagnostic & Statistical Manual
DSM-IV   Diagnostic & Statistical Manual of Mental Disorders, 4th Edition
EDI      Electronic Data Interchange
EIN      Employer Identification Number
EOB      Explanation of Benefits
EOC      Episode of Care
ERISA    Employee Retirement Income Security Act of 1974
ERN      Electronic Remittance Notice
ESRD     End Stage Renal Disease
FAQ      Frequently Asked Question
FDA      Food and Drug Administration
FFS      Fee for Service
FI       Fiscal Intermediary
FIG      Fiscal Intermediary Group
FLSA     Fair Labor Standards Act
FOI      Freedom of information
FOIA     Freedom of Information Act of 1966, etc.
FQHC     Federally Qualified Health Center
FR       Federal Register
FR       Final Rule
FTC      Federal Trade Commission
FY       Fiscal Year
GAAP     Generally Accepted Accounting Principles
GAF      Geographic Adjustment Factor
GAO      (U.S.) General Accounting Office
GDP      Gross Domestic Product
GI       Geographic Index
GNP      Gross National Product
GPCI     Government Practice Cost Index
GSA      General Services Administration
HCFA     Health Care Financing Administration (renamed CMS effective July 1, 2001)
HCPC       HCFA Common Procedure Code
HCPCS      Healthcare Common Procedure Coding System
HEDIS      Health Plan Employer Data and Information Set
HHS        (Department of) Health & Human Services (also DHHS)
HIAA       Health Insurance Association of America
HIPAA      Health Insurance Portability & Accountability Act of 1996
HOPPS      Hospital Outpatient Prospective Payment System
ICD-9-CM   International Classification of Diseases 9th Edition Clinical Modification
ICF        Intermediate Care Facility
IOM        Institute of Medicine
JCAHO      Joint Commission for Accreditation of Health Organizations
M+C        Medicare + Choice
MA         Medicare Advantage (formerly Medicare+Choice)
MAC        Major Ambulatory Category
MAC        Medicare Administrative Contractor
MCO        Managed Care Organization
MCPI       Medical Care Component of the Consumer Price Index
MDC        Major Diagnosis Category
MDC        Medicare Data Center
MEDB       Medicare Part B
MEDPAC     Medicare Payment Advisory Commission
MEI        Medical Economic Index
MFS        Medicare Fee Schedule
MIB        Medical Insurance Bureau
MMA        Medicare Modernization Act (of 1999)
MMSEA      Medicare, Medicaid & SCHIP Extension Act of 2007
MPFS       Medicare Physician Fee Schedule
MSA        Major Service Area
MSA        Medical Savings Accounts
MSA        Medical Statistical Area
MSA        Metropolitan Statistical Area (for PPS)
MSA        Medicare Savings Account
MUE        Medically Unlikely Edit
NCCI       National Correct Coding Initiative
NCI        National Cancer Institute
NCQA       National Committee for Quality Assurance
NIA        National Institute on Aging
NIST       National Institute of Standards & Technology
NMES       National Medical Expenditure Survey
NPF        National Provider File
NPI        National Provider Identifier
NPRM       Notice of Proposed Rulemaking
NPS        National Provider System
NQF        National Quality Forum
NQLC        National Quality Leadership Conference
NRC         Nuclear Regulatory Commission
NRM         Notice of Rule Making
OBRA        Omnibus Budget Reconciliation Act of 1981/1987/1989/1990
OCE         Outpatient Code Editor (System)
OIG         Office of the Inspector General
OMB         (HHS) Office of Management & Budget
OPPS        Outpatient Prospective Payment System
OSHA        Occupational Safety & Health Administration
P4P         Pay for Performance
PBA         Pharmacy Benefit Administrator
PCPI        AMA Physician Consortium for Performance Improvement®
PERVU       Practice Expense Relative Value Units
PFS         Medicare Physician Fee Schedule
POS         Place of Service
PPAC        Practicing Provider Advisory Council
PPAC        Prospective Payment Assessment Commission
PPR         Physician Payment Reform
PPR         Prospective Payment Review
PPRC        Physician Payment Review Commission
PPS         Prospective Payment System (Medicare Part A)
PQRI        Physician Quality Reporting Initiative
PRO         Peer Review Organization (renamed to QIO)
PRO         Professional Review Organization
PRO/FI      Professional Review Organization / Fiscal Intermediary
PROPAC      Prospective Payment Assessment Commission (Task Force)
PRRA        Paperwork Reduction Reauthorization Act
PRRB        Provider Reimbursement Review Board
PSRO        Performance Standards Review Organization
PVRP        Physician Voluntary Reporting Program
QRO         Quality Review Organization
RBRVS       Resource Based Relative Value Scale
RCC         Ratio of Cost to Charges
RCCAC       Ratio of Charges to Charges Applied to Costs
RVS         Relative Value Scale (or Schedule)
RVU         Relative Value Unit
RUC         AMA Relative Value Update Committee
SGR         Sustaintable Growth Rate
SMSA        Standard Metropolitan Statistical Area
SSA         Social Security Administration
T18         Title XVIII of the Social Security Act (Medicare)
T19         Title XIX of the Social Security Act (MAA (Medicaid))
TEFRA       Tax Equity & Fiscal Responsibility Act of 1982 (PL97248)
TITLE XIX   Grants to States for medical assistance programs (MAA)(Medicaid)
TITLE XVIII   Health Insurance (Medicare)
TN            Transmittal Number
TPA           Third Party Administrator
TRHCA         2006 Tax Relief and Health Care Act
U&C           Usual and Customary
UB-92         Uniform Billing form 92
UCC           Uniform Commercial Code
UCR           Usual, Customary & Reasonable (Charges)
UPIN          Unique or Universal Physician Identification Number
VBP           Value Based Purchasing
VMS           VIPS (Viable Information Processing Systems) Medicare System

				
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