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CRC ABBREVIATIONS

ABBREVIATIONS USED IN EXAM FOR AAPC CRC EXAM

ABBREVIATION TERM
RADV Risk Adjustment Data Validation
HHS Health and Human Services
MA Medicare Advantage
HCC Hierarchical Condition Category
IVC Initial Validation Contractor
MEAT Monitored Evaluated Addressed/Assessed or Treated
RAF Risk Adjustment Factor
FFS Fee For Service
HEDIS Healthcare Effectiveness Data Information Set
DME Durable Medical Equipment
PDE Prescription Drug Event
SNP Special Needs Plans
NCQA National Committee for Quality Assurance
CRG Clinical Risk Grouping
CDPS Chronic Illiness and Disability Payment Systems
TANF Temporary Assistance for Needy Families
SSD Selected Significant Disease
HHS-ACA Health and Human Services - Affordable Care Act
MCO Managed Care Organization
RAPS Risk Adjusting Processing System
ACG Adjusted Clinical Group
DCG Diagnosis Code Value
VH Very High
EL Extra Low
DPS Disability Payment System
PMH Past Medical History
MDM Medical Decision Making
AAPC American Academy of Professional Coders
ACR Adjusted Community Rates
ACRP Adjusted Community Rate Proposal
ADS Alternate Data Sources
ADL Activities of Daily Living
AGNS AT&T Global Network Services
AHA American Hospital Association
AHIMA American Health Information Management Association
AMA American Medical Association
ANSI American National Standards Institute
ANSI X12 837 Variable Length File Format for Electronic Submission of Encounter Data
ASC Ambulatory Surgical Center
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act 1999
BIC Beneficiary Identification Code
BIPA Benefits Improvement and Protection Act of 2000
CAD Coronary Artery Disease
CFO Chief Financial Officer
CHF Congestive Heart Failure
CMHC Community Mental Health Center
CMS Centers for Medicare & Medicaid Services
CMS-HCC CMS Refined Hierarchical Condition Category Risk Adjustment Model
COPD Chronic Obstructive Pulmonary Disease
CPT Current Procedural Terminology
CSSC Customer Service and Support Center
CVD Cerebral Vascular Disease
CWF Common Working File
CY Calendar Year
DCP Data Collection Period
DDE Direct Data Entry
DHHS Department of Health and Humana Services
DM Diabetes Mellitus
DME Durable Medical Equipment
DOB Date of Birth
DoD Department of Defense
DOS Dates of Service
DRG Diagnosis Related Group
DX Diagnosis
EDI Electronic Data Interchange
ESRD End Stage Renal Disease
ET Eastern Time
FERAS Front-End Risk Adjustment System
FFS Fee For Service
FQHC Federally Qualified Health Care Center
FTP File Transfer Protocol
GUI Graphical User Interface
H# MA Organizational CMS Contract Number
HCC Hierarchical Condition Category
HCFA 1500 Medicare Part B Claim Filing Form
HCPCS Healthcare Common Procedure Coding System
HEDIS Health Plan Employer Data Information Set
HIC# Health Insurance Claim Number (Beneficiary Medicare ID#)
HICN Health Insurance Claim Number (Beneficiary Medicare ID#)
HIPAA Health Insurance Portability and Accountability Act
HMO Health Maintenance Organization
HOS Health Outcomes Survey
HPMS Health Plan Management System
ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification
ICN Internal Claim Number
IP Internet Protocol
IVC Initial Validation Contractor
JCAHO Joint Commission on Accreditation of Health Care Organization
LTC Leading Through Change, Inc
MA Medicare Advantage
MA-PD Medicare Advantage Prescription Drug Plan
MARx Medicare Advantage Prescription Drug System
MBD Medicare Beneficiary Database
M+C organization Medicare + Choice Organization
MCCOY Managed Care Option Information System
MCO Managed Care Organization
MDCN Medicare Data Communications Network
MDS Minimum Data Set
MMA Medicare Prescription Drug Modernization Act of 2003
MMCS Medicare Managed Care System
MMR Monthly Membership Report
MnDHO Minnesota Disability Health Options
MOR Model Output Report
MSA Medical Savings Account
MSG Message
MSHO Minnesota Disability Health Options
NCH National Claims History
NCHS National Center for Health Statistics
NCPDP National Council on Prescription Drug Program
NCQA National Committee for Quality Assurance
NDM Network Data Mover
NEC Not Elsewhere Classified
NMUD National Medicare Utilization Database
NOS Not Otherwise Specified
NPI National Provider Identifier
NSF National Standard Format
OIG Office of Inspector General
OREC Original Reason for Entitlement Code
Palmetto GBA Palmetto Government Benefits Administrators
PACE Program of All-Inclusive Care for the Elderly
PCN Patient Control Number
PHS PACE Health Survey
PIP-DCG Principal Inpatient Diagnostic Cost Group
PPO Preferred Provider Organization
QIO Quality Improvement Organization
RAPS Risk Adjustment Processing System
RAPS Database Risk Adjustment Processing System Database
RAS Risk Adjustment System
RHC Rural Health Clinic
RPT Report
RRB Railroad Retirement Benefit
RT Record Type
RxHCC Prescription Drug Hierarchical Condition Category
SAS Statistical Analysis Software
SCO MassHealth Senior Care Option
SH# Submitter CMS Contract Number
S/HMO Social Health Maintenance Organizations
SNF Skilled Nursing Facility
SSD Selected Significant Disease Model
SSN Social Security Number
SUB ID Submitter ID
SVC Second Validation Contractor
TOB Type of Bill
UB-04 Uniform Billing Form 04
VA Veterans Administration
WPP Wisconsin Partnership Program
Created by: mseverino
 

 



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