Medical Insurance Abbreviations Flashcards

Medical Insurance Abbreviations

• NPP: Notice of Privacy Practice; outlines how health information is used and shared.
• OCR: Office of Civil Rights; enforces civil rights laws in healthcare.
• COB: Coordination of Benefits; the process to determine the order of payment when multiple insurances are involved.
• EP: Established Patient; a patient who has received care from the provider within a specified time frame.
• NP: New Patient; a patient who has not received care from the provider previously.
• NonPAR: Nonparticipating Provider; a provider who does not have a contract with a health plan.
• PAR: Participating Provider; a provider who has an agreement to provide services to a health plan's members.
• RTCA: Real Time Claims Adjudication; immediate processing of claims during a patient encounter.
• CC: Chief Complaint; the primary reason for a patient's visit.
• NEC: Not Elsewhere Classified; used to indicate a specific code is not available for a diagnosis.
• NOS: Not Otherwise Specified; indicates when detailed diagnosis is missing.
• CPT: Current Procedural Terminology; codes for procedures and services provided by healthcare professionals.
• DME: Durable Medical Equipment; medical equipment that can withstand repeated use.
• E/M Codes: Evaluation and Management Codes; codes for patient visits that require assessment and treatment.
• HCPCS: Healthcare Common Procedure Coding System; a set of codes for medical items not covered by CPT.
• PC: Professional Component; the portion of a billing related to the professional service provided.
• TC: Technical Component; the billing for technical services associated with tests.
• NUCC: National Uniform Claim Committee; organization that maintains the guidelines for electronic claims submissions.
• ASO: Administrative Services Only; services provided to manage health insurance plans without assuming risk.
• AP: Accounts Payable; liabilities of a company or organization for amounts owed to suppliers.
• AR: Accounts Receivable; money owed to a business for goods or services delivered.
• CDHP: Consumer Driven Health Plan; a health insurance plan that allows consumers more control over their healthcare choices.
• EHR: Electronic Health Records; digital records of patient health information.
• HIT: Health Information Technology; technologies used to store, share, and analyze health information.
• HMO: Health Maintenance Organization; provides health services for a fixed annual fee.
• MCO: Managed Care Organization; integrates the financing and delivery of healthcare services.
• PMPM: Per Member Per Month; a billing term that reflects monthly costs for each member in a plan.
• PMP: Practice Management Program; software solutions for managing a healthcare practice's operations.
• ACO: Accountable Care Organization; a group of healthcare providers that work together to deliver coordinated care.
• BA: Business Associate; an entity that performs functions on behalf of a covered entity that involves the use of protected health information.
• CMS: Centers for Medicare and Medicaid Services; federal agency that administers these programs.
• CE: Covered Entity; healthcare providers, health plans, and healthcare clearinghouses that transmit health information.
• DRS: Designated Record Set; a group of records maintained by a healthcare provider.
• EDI: Electronic Data Interchange; the interchange of data in a standardized format between organizations.
• E/M: Evaluation and Management; a category of codes used for billing patient assessments.
• HIE: Health Information Exchange; the electronic sharing of health information among organizations.
• HITECH: Health Information Technology for Economic and Clinical Health Act; promotes the adoption of health information technology.
• NPI: National Provider Identifier; unique identification number assigned to healthcare providers.
• NCD: National Coverage Determination; decision by CMS on whether a service is covered by Medicare.
• PQRS: Physician Quality Reporting System; program that encourages healthcare providers to report information on the quality of care.
• CHIP: Children's Health Insurance Plan; provides health coverage to eligible children in families with incomes too high to qualify for Medicaid.
• EPSDT: Early and Periodic Screening, Diagnosis and Treatment; Medicaid benefit for children under 21.
• FMAP: Federal Medical Assistance Program; provides federal funding for state Medicaid programs.
• MIP: Medicaid Integrity Program; ensures integrity of Medicaid services provided.
• TANF: Temporary Assistance for Needy Families; federal assistance program for low-income families.
• MTF: Military Treatment Facility; healthcare provider for military personnel and their families.
• NAS: Nonavailability Statement; documentation of healthcare service not available at military treatment facilities.
• PCM: Primary Care Manager; healthcare provider who oversees a patient's care in managed care systems.
• TRS: TRICARE Reserve Select; health insurance program for select reservists and their families.
• CHAMPVA: Civilian Health and Medical Program of the Department of Veterans Affairs; health care benefits for eligible dependents of veterans.
• CHAMPUS: Civilian Health and Medical Program of the Uniformed Services; now known as TRICARE.
• ERISA: Employee Retirement Income Security Act; federal law that sets minimum standards for pension plans.
• EOC: Episode Of Care; a series of healthcare-related interactions for a specific condition or treatment.
• FEHB: Federal Employees Health Benefits; health benefits program for federal employees and retirees.
• FSA: Flexible Savings Account; a pre-tax financial account for healthcare-related expenses.
• GHP: Group Health Plan; health plan sponsored by an employer.
• HRA: Health Reimbursement Account; employer-funded account for healthcare expenses.
• HSA: Health Savings Account; tax-advantaged medical savings account for individuals with high-deductible health plans.
• IHP: Individual Health Plan; health insurance purchased by individuals rather than through an employer.
• ABN: Advance Beneficiary Notice of Noncoverage; notice informing beneficiaries that Medicare may not pay for a service.
• AWV: Annual Wellness Visit; yearly visit established by Medicare for preventive service.
• CWF: Common Working File; database containing Medicare claims history.
• IPPE: Initial Preventive Physical Examination; a benefit for Medicare beneficiaries for preventive screening.
• LCD: Local Coverage Determination; guidelines for coverage based on local Medicare contractors.