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Acct. Account A/P ACCOUNT Payable A/R Account Receivable AMA American Medical Association ADJ Adjustment ABN Advanced Beneficiary Notice AHIMA American Health Information Management Association AEVS Automated Eligibility Verification System (health coverage information) AVRS Automated Voice Response System ALOS Average Length Of Stay AUTH Authorization BR Breast BC Body Composition , Blood Cells , Birth Control BS Blood Glucose, Bowel Sounds BC/BS Blue Cross/Blue Shield CC Chief Complaint C/C Credit Card CAL-MAX Calendar Max CERT Claims Eligible Real Time System, Community Emergency Response Team CSP Community Support Program , Compulsive Skin Picking CFL Calcaneofibular Ligament CHIP Child Health Insurance Program , Catastrophic Health Care Program CHAMPUS Civilian Health & Medical Programs of the Uniformed Services (Now TRI-CARE) CHAMPVA Civilian Health & Medical Program of the Veterans Administration CMS 1500 Medical claim form established by CMS to submit paper claims to Medicare and Medicaid. Most commercial insurance carriers also require paper claims be submitted on CMS-1500's. The form is distinguished by it's red ink. CO-PAY Co-Payment CO-INS CO-Insurance COBRA Consolidated Omnibus Budget Reconciliation Act (of 1985) COB Coordination of Benefits COB Coordination of Benefit COBC Coordination of Benefits Contractor CPT Current Procedural Terminology CCS Community Care Setting , Cardiovascular Society , Child Care Services, Corticosteroids CPC Certified Professional Coder Cont. Obj. Contractual Obligation DED Date of expected delivery DOS Date of Service , Date of Surgery DL Drivers License , Dose Level DRG Diagnosis Related Groups , Diagnostic Related Group (patients with similar illness) DOI Died Of Injuries DOB Date of Birth DDE Direct Data Entry DME Durable Medical Equipment (Medical supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.) DED Death Effect or Domain DEERS Defense Enrollment Eligibility Reporting System (DOD, CHAMPUS) DX Diagnosis Dr. Doctor ECS Extended Care Services , Electronic Certification System EDC Estimated Date Of Confinement EFT Electronic Funds Transfer EMC Electronic Media Claim EMR Electronic Medical Record System , Emergency Room ERA Electronic Remittance Advice. This is an electronic version of an insurance EOB that provides details of insurance claim payments. These are formatted in according to the HIPAA X12N 835 standard. ERN Electronic Remittance Notice ER Emergency Rooms , Extended Release EMG Electromyogram , Electromyographic E/M Evaluation & Management EIN Employer Identification Number ESRD End Stage Renal Disease EOB - Explanation of Benefits. One of the medical billing terms for the statement that comes with the insurance company payment to the provider explaining payment details, covered charges, write offs, and patient responsibilities and deductibles. EOMB Executive Office of Management & Budget General EOMB Explanation of Medical Benefits EDI Electronic Data Interchange EHR Electronic Health Record EHR Embryonic Heart Rate EPO Exclusive Provider Organization EPF Early pregnancy factor FECA Federal Employee Compensation Act FH Family History FPL Federal Poverty Level FFS Fee for Service FI Fiscal Intermediary- A Medicare representative who processes Medicare claims FSA Family Services Administration , Family Support Administration GRP Group HCFA Health Care Financing Administration (renamed CMS effective July 1, 2001) HIM Health Insurance Manual HPI History of Present Illness HC ...Hardcopy Claims HCPCS ...Healthcare Common Procedure Coding System HICN ...Health Insurance Claim Number (Medicare Number) HMO ...Health Maintenance Organization. A type of health care plan that places restrictions on treatments. HIPPA Health Insurance Portability and Accountability Act 1996. Several federal regulations intended to improve the efficiency and effectiveness of health care and establish IPA privacy and security laws for medical records. IPA Independent Practice Association , Individual Practice Association ICD-9-CM International Classification of Diseases 9th Edition Clinical Modification A system used to assign codes to patient diagnosis. This is a 3 to 5 digit number. ICD-10-CM International Classification of Diseases - 10th revision - Clinical Modification Uses 3 to 7 digit. Includes additional digits to allow more available codes. The U.S. Department of Health and Human Services has set an implementation deadline of October, 2013 for ICD-10. INS Insurance ID Identification Number ICF Intermediate Care Facility LMP Last Menstrual Period LC Low Complexity LT Laboratory test MCR Medicare MCD Medicaid MCL Median Collateral Ligament MEDI-MEDI Eligible for both Medicare and Medicaid M/M Major Medical , Male/Male MSA Medical Savings Accounts , Medical Savings Account Major Service Area MN Medical Necessity MN Medically Needy MRN Medical Record Number MSN Medicare Summary Notice MSP Medicare Secondary Payor MC Managed Care MD Medical Director MD Mood Disorders MDM Medium MCR Medicare Cost Report , Management Control Review Medical Cost Ratio NON-PAR Non-Participating When a healthcare provider chooses not to accept Medicare-approved payment amounts as payment in full. NC No complaints , No changes, Not Completed , Not Classified NPI National Provider Identifier , NPI Number - National Provider Identifier. A unique 10 digit identification number required by HIPAA and assigned through the National Plan and Provider Enumeration System (NPPES). NO PRESENT ILLNESS NCICS National Certified Insurance & Coding Specialist NCCT National Center for Competency Testing NP New Patient NEC No essential changes, Not elsewhere classifiable NOS Not Otherwise Specified. Used in ICD for unspecified diagnosis. NUBC National Uniform Billing Committee (AHA) NUCC National Uniform Claim Committee (AMA) NC Not Classified Not Completed No changes No complaints NOC Not Otherwise Classified NOC Nocturnal NOC Nursing Outcome Classification NF Nursing Facility NF Necrosis Factor NF Newly formed O/V Office Visit OCR Open Care Records, Outstanding Claims Reserve, Own Credit Risk, Optical Character Recognition OPPS Outpatient Prospective Payment System OR Operation Room OSHA Occupational Safety and Health Administration PAR Participating Provider, Patient Account Representative, Pain Relief Pt Patient PT Physical therapist PRO Patient Reported Outcome , Peer Review Organization (renamed to QIO) POS
"Point-of-Service plan. Medical billing terminology for a flexible type of HMO (Health Maintenance Organization) plan where patients have the freedom to use (or self-refer to) non-HMO network providers. When a non-HMO specialist is seen without referral from the Primary Care Physician (self-referral), they have to pay a higher deductible and a percentage of the coinsurance. "POS (Used on Claims) - Place of Service. Medical billing terminology used on medical insurance claims - such as the CMS 1500 block 24B. A two digit code which defines where the procedure was performed. For example 11 is for the doctors office, 12 is for home, 21 is for inpatient hospital, etc. POS Provider Organizations POS Posterior Pre-Cert Pre-Certification - Sometimes required by the patients insurance company to determine medical necessity for the services proposed or rendered. This doesn't guarantee the benefits will be paid. PRE-AUTH Pre-Authorization certain services and items must be prior authorized PRE-EX A pre-existing condition is a medical condition that started before a person's health insurance went into effect. Before 2014 some insurance policies would not cover expenses due to pre-existing conditions. PPO Preferred Provider Organization. Commercial insurance plan where the patient can use any doctor or hospital within the network. Similar to an HMO. PCP Primary Care Physician (or Provider) PPS Prospective Payment System (Medicare Part A) Phys Physical (body) Prov. Provider PF Pulmonary Fibrosis PD Physical Database , Personality Disorders PH Partial Hospitalization PH Physical Health PH Pulmonary Arterial Hypertension PE Practice Expense, Physical Examination, Premature Ejaculation PX Physical Examination, prescription, prognosis, physical history PA Physical Activity Physician Assistants Panic Attacks PC Personal Care PHI Private Health Insurance Personal Health Information Premium Hospital Insurance Protected Health Information QMBs Qualified Medicare Beneficiaries RA Risk Assessment , Rheumatoid Arthritis RBRVS Resource-based relative value scale Managed Care A 'work unit' used to determine the value of various physicians' labor. See Medicare, Physician reimbursement. RVS Relative Value Scale (or Schedule) RVS Relative Value Study RVU Relative Value Unit ROS Review of Systems RHIA Registered Health Information Administrator REP Representative, Rab Escort Protein, Reperfusion RT Right, Recovery Time, Respiratory Therapy, Reverse transcribed, Radiation therapy RVS Reverse, Rhus verniciflua Stokes SF Short Form Sugar-Free SDI State Disability Insurance Survey Diagnostic Instrument SNF Skilled Nursing Facility SOC Start of Care, Standard of Care SSN Social Security Number SSDI Social Security Disability Insurance SSI Supplemental Security Income SOF Signature on File , Synthetic Oviduct Fluid, Study of Osteoporotic Fractures TC To Contain Tobacco Control TIN Tax Identification Number TIN Tax Identification Number. Also known as Employer Identification Number EIN TIN Three times a night TD to Deliver TPP Third Party Processors TANF Temporary Assistance for Needy Families TPL Third Party Liability TFL TRICARE for Life (health care system for retired military) UB-04 The UB-04 is the red-ink on white paper standard claim form used by institutional providers for claim billing. Although it was developed by The Centers for Medicare and Medicaid (CMS), it has become the standard form used by all insurance carriers. UCR Usual, Customary & Reasonable (Charges) UA Urinalysis , Urine Analysis UR Upon Receipt , Urinary retention , Urine , Upper Respiratory, Under W/O Write Off ,Week of, Without WC Workers Compensation WP Work Place Clavicle collarbone Scapula shoulder bone/shoulder blade Humerus upper arm bone Ulna forearm bone little finger side Radius forearm bone in line with the thumb Carpals wrist bones 2 rows of four Metacarpals five bones of the palm of the hand Phalanges five finger bones Pelvic Girdle pelvis Femur only bone in the thigh Patella kneecap Tibia shinbone second largest bone in the body Fibula calf bone Tarsals in feet / ankle bones / 7 in each foot / hind foot bones Metatarsals 5 long bones in foot / mid foot bones Phalanges of the toes bones of the toes "
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