Useful Acronyms

    There are so many things that you need to know and this article should help you better understand what you are reading.

  1. Aging Report- Aging report allows a biller to review the AR and work the older claims first. An AR Aging Report is a common report used to provide an AR specialist with the ability to work on the oldest claims first.  AR is sorted by 0-30, 31-60, 61-90, 91-120, >120
  2. AR- (Accounts Receivable) can refer to monies owed by insurance companies or patients.  Usually will be formatted by insurance companies and the aging of the claims displayed.
  3. ARRA-American Recovery and Reinvestment Act of 2009, abbreviated ARRA, is an economic stimulus package enacted by the 111th United States Congress in February 2009.
  4. ASC-(Ambulatory Surgical Center) this is an outpatient surgical facility where procedures are performed that are too difficult for the office.  A facility charge is billed in conjunction with the physician’s professional component.  The facility charge is similar to how the hospital bills for their services but it is much less. (**Insurance companies prefer for a physician to perform cases in an ASC vs Hospital because it saves them a lot of money**)
  5. ASP-Stands for Type of hosting platform used with practice management and emr software.  Allows user to access the software through a standard internet connection.
  6. CDO-Care delivery organization such as a medical practice or hospital
  7. CCR, CCD- Continuity of Care Record or Document as is simply the patient’s medical record in an electronic format.
  8. Charges-The amount billed out by the practice for the services rendered.  This is determined by the office and can be anywhere from 100%-500% of Medicare
  9. CMS-Centers for Medicare and Medicaid Services
  10. CPT-(Current Procedural Terminology) The CPT code set is maintained by the AMA (American Medical Association) and accurately describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
  11. EDI- Electronic Data Interchange which is the electronic transfer of secure documents.  Banks, medical companies and many other organizations operate using this type of interchange.
  12. EHR- Electronic Health Records.
  13. EMR- Electronic Medical Record.  For the purposes of this list these two systems accomplish the same thing but for a more detailed explanation you can read the article on Differences between EMR & EHR
  14. ERA- (Electronic Remittance Advice) electronic version of an EOB.  ERAs are used within many programs to autopost the payments freeing up substantial time and creating a more efficient billing operation.
  15. E&M Codes- Evaluation and Management codes.  This designation includes your standard office visits and hospital consults.  (Ex: 99213, 99203)
  16. EOB- (Explanation of Benefits) used to explain how a claim was paid by insurance company.
  17. Fee Schedule- Used to describe an offices set fee schedule or what they bill out for services rendered.  Usually 150%-200% of Medicare.  Also can be used to describe an established fee schedule outlining what the insurance company has agreed to pay an office.  Can be anywhere from 70%-150% of Medicare.
  18. GCR-Gross Collection rate
  19. HL7-Health Level Seven (HL7), is an all-volunteer, not-for-profit organization involved in development of international healthcare standards. “HL7” is also used to refer to some of the specific standards created by the organization (i.e. HL7 v2.x, v3.0, HL7 RIM etc.).  HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing and retrieval of electronic health information. v2.x of the standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world. From Wikipedia.com
  20. ICD-9- International Statistical Classification of Diseases and Related Health Problems.  ICD-9 Codes are billed along with CPT codes and are required in order for a claim to be paid.  E&M Codes do not require diagnosis codes because they are not procedures but consultative in nature.
  21. Insurance Allowable-What the insurance company agrees to pay based on their contract.
  22. NCR-Net Collection rate
  23. Payor Mix-This is a report generated by an office that lists the different insurance companies with the number of members for each one.  Used when renegotiating contracts to indentify the companies with the most members.
  24. RCM- Revenue Cycle Management or the billing and collections process.
  25. T1-Internet connection that can supply secure and dedicated connectivity and bandwidth for an organization.
  26. Timely filing-  This is a term referring to the rules that insurance companies have in regards to how long an organization has to bill for services after the initial date of service.  If an insurance company denies a claim, the practice or facility has a limited amount of time to correct the claim and rebill for the services.  If they wait after the deadline established by the insurance company, then the insurance company is not obligated to pay the claim.  The timely filing rules average around 60 days.
  27. NP, PA- (Nurse Practitioner, or Physician Assistant) These are designated as Non Physician Providers (NPP), Mid-Level Practitioners or Physician Extenders and are commonly used by physicians to make them more efficient and their offices more productive.
  28. PM- Used when referring to Practice Management software.
  29. PMB-Practice Management and Billing Software
  30. HL7- Coding language that most practice management and emr programs use.  Programs using this language can more easily be integrated when necessary because they are built on a common platform.
  31. PQRI- The Physician Quality Reporting Initiative establishes a financial incentive for physicians and other health practitioners to participate in a voluntary quality reporting program. Eligible professionals who successfully report data for a designated set of quality measures may earn a bonus payment.  The PQRI measures apply to services that eligible professionals provide to Medicare or Medicaid beneficiaries in their offices and other settings. CMS is implementing an extensive outreach and education plan to assist eligible professionals to understand the program and the measures and to implement processes to efficiently capture the quality data that is to be reported under the PQRI program. There are over 186 programs as outlined here: http://www.cms.hhs.gov/PQRI/Downloads/2009_PQRI_MeasuresList_030409.pdf Programs include E-prescribe, wound compression studies, diabetes, heart failure, and much more.
  32. 2009 PQRI- Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible Physicians(EP) who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 – December 31, 2009, or July 1, 2009- December 31, 2009 will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2009 calendar year).
  33. SaaS-Software as a Service ( ‘sass’) is a software deployment model whereby a provider licenses an application to customers for use as a service on demand.  SaaS software vendors typically host the application on their own web servers but also can download the application to the consumer device.  The SaaS program would be disabled after use or after the on-demand contract expires. The on-demand function may be handled internally to share licenses within a firm or by a third-party application service provider (ASP) sharing licenses between firms.
  34. VPN- Virtual private network.  Creates a secure tunnel that allows users to remotely access computers and the programs on the computer.  Similar to a remote desktop function.

More Acronyms from Meaningful Use Rule:

  • ARRA American Recovery and Reinvestment Act of 2009
  • CAH Critical Access Hospital
  • CMS-0033-P 6
  • CAHPS Consumer Assessment of Healthcare Providers and Systems
  • CCN CMS Certification Numbers
  • CHIP Children’s Health Insurance Program
  • CHIPRA Children’s Health Insurance Program Reauthorization Act of 2009
  • CMS Centers for Medicare & Medicaid Services
  • CY Calendar Year
  • EHR Electronic Health Record
  • EP Eligible Professionals
  • EPO Exclusive Provider Organization
  • FACA Federal Advisory Committee Act
  • FFP Federal Financial Participation
  • FFS Fee-For-Service
  • FQHC Federally Qualified Health Center
  • FTE Full-Time Equivalent
  • FY Fiscal Year
  • FFY Federal Fiscal Year
  • HEDIS Healthcare Effectiveness Data and Information Set
  • HHS Department of Health and Human Services
  • HIE Health Information Exchanges
  • HIT Health Information Technology
  • HIPPA Health Insurance Portability and Accountability Act of 1996
  • HITECH Health Information Technology for Economic and Clinical Health Act
  • HMO Health Maintenance Organization
  • CMS-0033-P 7
  • HOS Health Outcomes Survey
  • HPSA Health Professional Shortage Area
  • HRSA Health Resource Services Administration
  • IAPD Implementation Advanced Planning Document
  • IPA Independent Practice Association
  • IHS Indian Health Services
  • IT Information Technology
  • MA Medicare Advantage
  • MAC Medicare Administrative Contractor
  • MCO Medicaid managed care organization
  • MITA Medicaid Information Technology Architecture
  • MMIS Medicaid Management Information Systems
  • MSA Medical Savings Account
  • NCQA National Committee for Quality Assurance
  • NCVHS National Committee on Vital and Health Statistics
  • NPI National Provider Identifier
  • ONC Office of the National Coordinator for Health Information Technology
  • PAHP Prepaid Ambulatory Health Plan
  • PAPD Planning Advanced Planning Document
  • PIHP Prepaid Inpatient Health Plan
  • PFFS Private Fee-For-Service
  • PHO Physician Hospital Organization
  • PHS Public Health Service
  • CMS-0033-P 8
  • POS Place of Service
  • PPO Preferred Provider Organization
  • PSO Provider Sponsored Organization
  • RHC Rural Health Clinic
  • RPPO Regional Preferred Provider Organization
  • SMHP State Medicaid Health Information Technology Plan
  • TIN Tax Identification Number