Acronym Definition(s) Note: These acronyms may have other definitions, but those listed are intended to be HHS/CMS oriented

Transcription

1 A AAC AAPC Actual Acquisition Cost (the net cost of a drug paid by a pharmacy) Adjusted Average Per Capita Cost (amount of funding a Medicare managed care plan receives from CMS to cover its costs) ACA Patient Protection and Affordable Care Act (of 2010) ACF ACO ADA ADL AHLAT AHRQ ANSI APC APD APG APHSA Administration for Children and Families Accountable Care Organization 1. Americans with Disabilities Act 2. American Dental Association Activities of Daily Living (activities performed by individuals without assistance) Armed Forces Health Longitudinal Technology Application (Department of Defense (DoD) electronic health record (EHR) system) Agency for Healthcare Research and Quality American National Standards Institute Ambulatory Payment Classification Advance Planning Document Ambulatory Patient Group American Public Human Services Association ARRA American Recovery and Reinvestment Act of 2009 ASC X12 ASCII Accredited Standards Committee (chartered by the American National Standards Institute to develop electronic data interchange (EDI) standards) American Standard Code for Information Interchange B BAA BENDEX BI BPM Business Associate Agreement (mandatory under the Health Insurance Portability and Accountability Act (HIPAA)) Beneficiary and Earnings Data Exchange 1. Background Investigation 2. Benefits Integrity 3. Business Intelligence Business Process Management or Model C CAP CAQH CBA CCF 1. Corrective Action Plan 2. Cost Allocation Plan Council for Affordable Quality Healthcare Cost/Benefit Analysis Center for Children and Families

2 CCHIT CCI CCIIO CDC CDM CESA CFR CHIP Certification Commission for Healthcare Information Technology Correct Coding Initiative (a large set of procedure code edits adopted by Medicaid) Center for Consumer Information and Insurance Oversight Centers for Disease Control and Prevention 1. Charge Description Master (Hospital Files) 2. Conceptual Data Model 3. Canonical Data Model Cooperative Education Service Agency (Wisconsin only) Code of Federal Regulations 1. Children's Health Insurance Program 2. Catastrophic Health Care Program CHIPRA Children's Health Insurance Program Reauthorization Act of 2009 CLIA Clinical Laboratory Improvement Act of 1965 (with amendments in 1988) CM CMCS CMHC CMI CMMI CMS COB COBA COLA CORE COS COTS CPHA CPT CRF CRN CSP CRNP 1. Clinical Management 2. Configuration Management 1. Center for Medicaid and Children's Health Insurance Program (CHIP) Services 2. Center for Medicaid, CHIP, and Survey and Certification Community Mental Health Center Case Mix Indicator (a relative value assigned to a diagnosis-related group of patients in a medical care environment) Capability Maturity Model Integration Centers for Medicare and Medicaid Services Coordination of Benefits Coordination of Benefits Agreement Cost-of-Living Adjustment Committee on Operating Rules for Information Exchange Category of Service (assigned codes to identify approved services) Commercial Off-the-Shelf (software) Commission on Professional and Hospital Activities Current Procedural Terminology 1. Community Resident Facility 2. Change Request Form Claim Reference Number 1. Customer Service Plan 2. Customer Service Program Certified Registered Nurse Practitioner

3 CSR 1. Customer Service Representative 2. Customer Service Record D DAW DBMS DCN DDI DEA DEERS DESI DGB DHS DHHS DME DRG DSD DSH DSMO DSS DUR DW Dispense as Written Database Management System Document Control Number 1. Design, Development, and Implementation 2. Design, Develop, and Implement Drug Enforcement Administration (or Agency) Defense Enrollment Eligibility Reporting System (Department of Defense) Drug Efficacy Study Implementation Data Governance Board 1. Department of Human Services 2. U.S. Department of Homeland Security U.S. Department of Health and Human Services 1. Durable Medical Equipment 2. Distributed Management Environment Diagnosis Related Group Detailed System Design Disproportionate Share Hospital Designated Standards Maintenance Organization Decision Support System Drug Utilization Review Data Warehouse E EA EAC ECS EDH Interchange EDI EFT EHR 1. Enterprise Architecture 2. Emergency Assistance 1. Estimated Acquisition Cost (for drugs) 2. Estimate at Completion Electronic Claim Submission (insurance) Enterprise Data Hub Electronic Data Interchange Electronic Funds Transfer Electronic Health Record

4 EITA EMC EMR EOMB EOP ephi EPSDT EQRO ERP ESB ETL EVS Exchange Information Technology Architecture Electronic Media Claims (same as Electronic Claim Submission) Electronic Medical Record 1. Explanation Of Medical Benefits 2. Explanation of Medicare Benefits 3. Executive Office of Management and Budget Explanation of Payment Electronic Protected Health Information Early and Periodic Screening, Diagnosis, and Treatment (Program or Services) External Quality Review Organization (a peer review organization-like entity) 1. Estate Recovery Program (Medicaid collection against the estate of deceased recipients 55 or older when assistance was issued) 2. Enterprise Resource Planning Enterprise Service Bus (software architecture model used for designing and implementing communication between mutually interacting software) Extract, Transform, and Load Eligibility Verification System F FA FEPS FFE FFP FHA FI FMAC FMAP FPL FPW FQHC FWA 1. Fiscal Agent 2. Fraud and Abuse Federal Exchange Program System Federally-Facilitated Exchange Federal Financial Participation 1. Federal Health Architecture 2. Federal Housing Administration 3. Federal Highway Administration Fiscal Intermediary Federal Maximum Allowable Cost 1. Federal Medical Assistance Percentage 2. Federal Medical Assistance Payments Federal Poverty Level Family Planning Waiver (Program or Plan) Federally Qualified Health Center Fraud, Waste, and Abuse G GAMC General Assistance Medical Care

5 GPRA Government Performance Results Act (of 1993) H HCBS HCBW HCPCS HDX HEDIS HHS HIE HIMSS Home and Community Based Service Home and Community Based Waiver (Program) Healthcare Common Procedure Coding System Healthcare Data Exchange 1. Health Employer Data and Information Set 2. Healthcare Effectiveness Data and Information Set (HEDIS ) 3. Healthplan Employer Data and Information Sets U.S. Department of Health and Human Services Health Information Exchange 1. Health Information and Management Systems Society 2. Healthcare Information and Management Systems Society (American Hospital Association) HIPAA Health Insurance Portability and Accountability Act of 1996 HIPP HIPPS HISPC HIT HITECH HITSP HIX HL7 HMO Health Insurance Premium Payment (Program) Health Insurance Prospective Payment System (a CMS payment code system) Health Information Security and Privacy Collaboration Health Information Technology Healthcare Information Technology for Economic and Clinical Health Act Healthcare Information Technology Standards Panel Health Insurance Exchange Health Level Seven (a set of international standards for transfer of clinical and administrative data between hospital information systems (Global authority in standards for interoperability of Health Information Technology)) Health Maintenance Organization I IAPD IBP ICD-10 Implementation Advance Planning Document 1. Industry Best Practices 2. Implementing Best Practices International Statistical Classification of Disease and Related Health Problems (10th revision) IC/MR Intermediate Care Facility for the Mentally Retarded (reclassified, based on Rosa s Law in 2010) ICF/IID Intermediate Care Facility for Individuals with Intellectual Disabilities

6 ICN IDIQ IE&E IEEE IES IHS IMD ISO ISP ITIL IV&V 1. Internal Control Number (used to uniquely identify MMIS health care claims) 2. In-house Claim Number 3. Inquiry Control Number 4. Intermediary Control Number 5. Inventory Control Number 1. Indefinite Delivery/Indefinite Quantity 2. Indefinite Duration, Indefinite Quantity Integrated Eligibility and Enrollment( a mandate of Patient Protection and Affordable Care Act of 2010 (PPACA)) Institute of Electrical and Electronics Engineers Integrated Eligibility System Indian Health Service 1. Institution for Mental Diseases 2. Institute for Mental Disease International Organization for Standardization Individual Service Plan Information Technology Infrastructure Library Independent Verification and Validation J JAD JAR Joint Application Design Joint Application Requirements L LDM LTC LTCH Logical Data Model Long-Term Care Long-Term Care Hospital M M&M MARS MARX MBE MBES MCH Medicare and Medicaid 1. Management and Administrative Reporting System 2. Management and Administrative Reporting Subsystem 3. Medicare Accounts Receivable System Medicare Advantage and Prescription Drug System 1. Minority Business Enterprise 2. Medicaid Budget and Expenditures Medicaid Budget and Expenditure System Maternal and Child Health

7 MCO Managed Care Organization MECT Medicaid Enterprise Certification Toolkit MEQC Medicaid Eligibility Quality Control (System) MESC Medicaid Enterprise Systems Conference (replaced Medicaid Management Information Systems (MMIS) Conference in 2012) MFCU Medicaid Fraud Control Unit MITA Medicaid Information Technology Architecture MMA Medicare Modernization Act of 1999 (updated in 2003) MMIS Medicaid Management Information System MOTS Modified Off-the-Shelf N NAMPI NASCIO NASMD NCPDP NDC NHIN NHIS NIEM NIST NMEH NPDB NPI NPI Enumerator NPP NPPES NwHIN National Association for Medicaid Program Integrity (replaces NASO, the National Association of Surveillance and Utilization Review Subsystem (SURS) Officials) National Association of State Chief Information Officers National Association of State Medicaid Directors National Council for Prescription Drug Programs National Drug Code Nationwide Health Information Network (now referred to as the ehealth Exchange) 1. National Health Information System 2. National Health Interview Survey National Information Exchange Model National Institute of Standards and Technology National Medicaid EDI HIPAA Workgroup National Practitioner Data Bank National Provider Identifier CMS contractor responsible for assisting health care providers in applying for their NPIs and updating their information in the National Provider and Plan Enumeration System 1. Notices of Privacy Practices 2. Non-Physician Practitioner National Provider and Plan Enumeration System Nationwide Health Information Network (now referred to as the ehealth Exchange) O OASIS OBRA OIS Outcome and Assessment Information Set Omnibus Budget Reconciliation Act Office of Information Services (of CMS)

8 OLAP ONC OPPS OSCAR Online Analytical Processing Office of the National Coordinator for Health Information Technology Outpatient Prospective Payment System 1. Online Survey Certification and Reporting (System) 2. Office of Standards and Certification Automated Retrieval (System) P P4P PA PACE PAL PAM PAPD PARIS PASARR PBM PCCM PCP PCPCM PCS PDA PE PECOS Pay for Performance 1. Prior Authorization 2. Privacy Act of Project Assessment 1. Program of All-Inclusive Care for the Elderly 2. Pharmaceutical Assistance Contract for the Elderly (Program) 3. Planning, Assigning, Controlling, and Evaluating System Provider Audit List 1. Payment Accuracy Measurement 2. Priority Audit Memorandum 3. Project Administration Manual Planning Advance Planning Document Public Assistance Reporting Information System Preadmission Screening and Resident Review Pharmacy Benefit Management or Manager Primary Care Case Management or Manager Primary Care Physician or Provider Primary Care Physician Case Manager Procedure Coding System 1. Personal Digital Assistant 2. Premium Due Amount 1. Presumptive Eligibility 2. Practice Expense 3. Performance Evaluation 4. Post Entitlement 5. Program Evaluation Provider Enrollment, Chain and Ownership System PERM Payment Error Rate Measurement (Act of amended in 2010) Payment Error Reduction and Measurement PHDSC Public Health Data Standards Consortium

9 PHI PHIN PHP PHR PIP PKI PMBOK PMI PMO PMP PPACA PPO PRO PSTG 1. Protected Health Information 2. Private Health Insurance Public Health Information Network (national initiative, developed by the CDC) 1. Prepaid Health Plan 2. Partial Hospitalization Program 1. Personal Health Record 2. Professional Health Research 1. Periodic Interim Payment 2. Performance Improvement Plan 3. Physician Incentive Plan 4. Productivity Improvement Program Public Key Infrastructure Project Management Body of Knowledge Project Management Institute Project Management Office Project Management Professional Patient Protection and Affordable Care Act (of 2010) (commonly called the Affordable Care Act (ACA)) Preferred Provider Organization Peer Review Organization (renamed Quality Improvement Organization) Private Sector Technology Group Q QA QAE QC QDWI QIO QM QMB 1. Quality Assurance 2. Quality Assessment Quality Assurance Evaluator Quality Control Qualified Disabled and Working Individual Quality Improvement Organization (current term for Peer Review Organization) Quality Management Qualified Medicare Beneficiary R RA RAC RAMS Risk Assessment Recovery Audit Contractor (Program) Requirements Analysis Management System Reliability, Availability, Maintainability, Safety (Analysis)

10 REC REOMB RHIO ROSI RUG Regional Extension Center Recipient Explanation of Medical Benefits Regional Health Information Organization Reconciliation of State Invoice Resource Utilization Group S SACWIS SAMHSA SBE SCHIP SDLC SDO SDW SDX SEI SLA SMHP SME SMM SNAP SNF SNIP SOA SOBRA SOLQ SOW SQL SS-A SSA SSOP S-TAG Statewide Automated Child Welfare Information System Substance Abuse and Mental Health Services Administration State-based Exchange State Children's Health Insurance Program (currently named Children s Health Insurance Program) 1. System Development Life Cycle 2. Software Development Life Cycle Standards Development Organization Shared Data Warehouse State Data Exchange Software Engineering Institute Service Level Agreement State Medicaid Health Information Technology (HIT) Plan Subject Matter Expert State Medicaid Manual Supplemental Nutrition Assistance Program Skilled Nursing Facility Strategic National Implementation Process Service-Oriented Architecture Sixth Omnibus Budget Reconciliation Act State Online Query (the Social Security Administration s system to authenticate access to individual social security records) 1. Scope of Work 2. Statement of Work Structured Query Language State Self-Assessment (a tool or report that is a component of MITA) Social Security Administration Second Surgical Opinion Program State Systems Technical Advisory Group

11 STAG SUR SURS System Technical Advisory Group Surveillance and Utilization Review Surveillance and Utilization Review Subsystem T TAG TANF TPA TPL Technical Advisory Group Temporary Assistance for Needy Families 1. Third Party Administrator 2. Trading Partner Agreement (required under section 201(a)(5) of the HIPAA) Third-Party Liability V VA U.S. Department of Veterans Affairs W WBE WBS WEDI WIC Woman-Owned Business Enterprise Work Breakdown Structure or Schedule Workgroup for Electronic Data Interchange Women, Infants, and Children (federal program to ensure proper nutrition (special supplemental nutrition program)) X X12 American National Standards Institute (ANSI) (committee responsible for EDI standards)