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Medical Terms for Billing and Coding

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A
ABLATION
ABSTRACT
ABUSE
ACCESS
ACCESSIBILITY OF SERVICES
ACCESSORY DWELLING UNIT (ADU)
ACCREDITATION
ACCREDITATION CYCLE FOR M-C DEEMING
ACCREDITATION FOR DEEMING
ACCREDITATION FOR PARTICIPATION
ACCREDITED (ACCREDITATION)
ACCREDITED STANDARDS COMMITTEE
ACT, LAW, STATUTE
ACTIVITIES OF DAILY LIVING (ADL)
ACTUAL CHARGE
ACTUARIAL BALANCE
ACTUARIAL DEFICIT
ACTUARIAL RATES
ACTUARIAL SOUNDNESS
ACTUARIAL STATUS
ACUPUNCTURE
ACUTE
ADD-ON-CODE
ADDITIONAL BENEFITS
ADJUSTED AVERAGE PER CAPITA COST (AAPCC)
ADJUSTED COMMUNITY RATING (ACR)
ADMINISTRATIVE CODE SETS
ADMINISTRATIVE COSTS
ADMINISTRATIVE DATA
ADMINISTRATIVE EXPENSES
ADMINISTRATIVE LAW JUDGE (ALJ)
ADMINISTRATIVE SERVICES ONLY
ADMINISTRATIVE SIMPLIFICATION
ADMINISTRATIVE SIMPLIFICATION COMPLIANCE ACT
ADMINISTRATOR
ADMISSION DATE
ADMITTING DIAGNOSIS CODE
ADMITTING PHYSICIAN
ADULT LIVING CARE FACILITY
ADVANCED CONTRACT BILLING CODES(ABC CODES)
ADVANCE BENEFICIARY NOTICE (ABN)
ADVANCE COVERAGE DECISION
ADVANCE DIRECTIVES
ADVANCE DIRECTIVE (HEALTH CARE)
ADVERSE EFFECTS
ADVISORY COUNCIL ON SOCIAL SECURITY
ADVOCATE
AFFILIATED CONTRACTOR
AFFILIATED PROVIDER
AGED ENROLLEE
ALBUMIN
ALGORITHM
ALLOWED CHARGE
AMBULANCE (AIR OR WATER)
AMBULANCE (LAND)
AMBULATORY
AMBULATORY CARE
AMBULATORY CARE SENSITIVE CONDITIONS
AMBULATORY SURGICAL CENTER
AMENDMENTS AND CORRECTIONS
AMERICAN ASSOCIATION FOR HOMECARE
AMERICAN DENTAL ASSOCIATION
AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION
AMERICAN HOSPITAL ASSOCIATION
AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS
AMERICAN MEDICAL ASSOCIATION
AMERICAN MEDICAL INFORMATICS ASSOCIATION
AMERICAN NATIONAL STANDARDS
AMERICAN NATIONAL STANDARDS INSTITUTE
AMERICAN SOCIETY FOR TESTING AND MATERIALS
AMNIOCENTESIS
AMORTIZATION
AMPUTATION
ANALGESIC
ANASTOMOSIS
ANCILLARY SERVICES
ANEMIA
ANESTHESIA
ANGIODYSPLASIA
ANNUAL ELECTION PERIOD
ANTIBODY (AB)
ANTIGEN (AG)
APPEAL
APPEAL PROCESS
APPROVED AMOUNT
ARCTATION (COARCTATION)
AREA AGENCY ON AGING (AAA)
ARTERY
ARTHROCENTESIS
ARTHRODESIS
ARTHROPLASTY
ASPHYXIA
ASPIRATION
ASSESSMENT
ASSETS
ASSIGNED CLAIM
ASSIGNMENT
ASSISTED LIVING
ASSOCIATION FOR ELECTRONIC HEALTH CARE TRANSACTIONS
ASSUMPTIONS
ATTACHMENT(S)
ATTENDING PHYSICIAN
AUTHORITATIVE APPROVAL
AUTHORITATIVE EVIDENCE
AUTHORIZATION
AUTOMATED CLAIM REVIEW
AVERAGE MARKET YIELD

B
BABY BOOM
BALANCE BILLING
BASE ESTIMATE
BASIC BENEFITS
BASIC BENEFITS (MEDIGAP POLICY)
BENCHMARK
BENEFICIARY
BENEFICIARY ENCRYPTED FILE
BENEFICIARY NOTIFICATION LETTER
BENEFITS
BENEFITS DESCRIPTION (PLAN)
BENEFIT PAYMENTS
BENEFIT PERIOD
BIOLOGICALS
BIOMETRIC IDENTIFIER
BIRTHING CENTER
BLOOD UREA NITROGEN
BLUE CROSS AND BLUE SHIELD ASSOCIATION
BOARD-CERTIFIED
BOARD AND CARE HOME
BOARD HEARING
BOARD OF TRUSTEES
BODY RECORD
BOND
BONUS
BUSINESS ASSOCIATE
BUSINESS MODEL
BUSINESS PARTNER
BUSINESS RELATIONSHIPS

C
CADAVERIC TRANSPLANT
CALLABLE
CAPITATION
CAPPED RENTAL ITEM
CAREGIVER
CARE PLAN
CARRIER
CASE-MIX
CASE MANAGEMENT
CASE MANAGER
CASE MIX
CASH BASIS
CATASTROPHIC ILLNESS
CATASTROPHIC LIMIT
CENTERS FOR DISEASE CONTROL AND PREVENTION
CENTER FOR HEALTHCARE INFORMATION MANAGEMENT
CERTIFICATE OF INDEBTEDNESS
CERTIFICATE OF MEDICAL NECESSITY
CERTIFIED (CERTIFICATION)
CERTIFIED NURSING ASSISTANT (CNA)
CERTIFIED REGISTERED NURSE ANESTHETIST
CHAIN OF TRUST
CHAIN OF TRUST AGREEMENT
CHRONIC MAINTENANCE DIALYSIS
CIVILIAN HEALTH AND MEDICAL PROGRAM (CHAMPUS)
CLAIM
CLAIM ADJUSTMENT REASON CODES
CLAIM ATTACHMENT
CLAIM STATUS CATEGORY CODES
CLAIM STATUS CODES
CLINICAL BREAST EXAM
CLINICAL PERFORMANCE MEASURE
CLINICAL PRACTICE GUIDELINES
CLINICAL TRIALS
CMS-1450
CMS-1500
CMS AGENT
CMS DIRECTED IMPROVEMENT PROCESS
CODE OF FEDERAL REGULATIONS
CODE SET
CODE SET MAINTAINING ORGANIZATION
COGNITIVE IMPAIRMENT
COHORT
COINSURANCE (MEDICARE PRIVATE FEE-FOR-SERVICE PLAN)
COINSURANCE (OUTPATIENT PROSPECTIVE PAYMENT SYSTEM)
COLLEGE OF HEALTHCARE INFORMATION MANAGEMENT EXECUTIVES
COMMENT
COMMERCIAL MCO
COMMUNITY MENTAL HEALTH CENTER
COMPLAINT
COMPLAINT (OF FRAUD OR ABUSE)
COMPLIANCE DATE
COMPREHENSIVE INPATIENT REHABILITATION FACILITY
COMPREHENSIVE MCO
COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY
COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF)
COMPUTER-BASED PATIENT RECORD INSTITUTE-HEALTHCARE OPEN SYSTEMS AND TRIALS
COMPUTER MATCHING AGREEMENT
CONDITIONAL PAYMENT
CONFIDENTIALITY
CONSENT AND AUTHORIZATION (BASIC RULE)
CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA)
CONSUMER-PRICE
CONSUMER ASSESSMENT OF HEALTH PLANS STUDY (CAHPS)
CONSUMER SELF-REPORT DATA
CONSUMER SURVEY DATA
CONTINGENCY
CONTINGENCY MARGIN
CONTINUATION OF ENROLLMENT
CONTINUING CARE RETIREMENT COMMUNITY (CCRC)
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
CONTINUOUS CYCLING PERITONEAL DIALYSIS
CONTINUOUS QUALITY IMPROVEMENT
CONTRACTOR
CONTRIBUTIONS
CONTRIBUTION BASE
COORDINATED CARE PLAN
COORDINATION OF BENEFITS
COORDINATION PERIOD
COST-BASED HEALTH MAINTENANCE ORGANIZATION
COST RATE
COST REPORT
COST SHARING
COVERAGE ANALYSIS FOR LABORATORIES (CALS)
COVERAGE BASIS
COVERAGE ISSUES MANUAL (CIM)
COVERED BENEFIT
COVERED CHARGES
COVERED EARNINGS
COVERED EMPLOYMENT
COVERED ENTITY
COVERED FUNCTION
COVERED SERVICES
COVERED WORKER
CREDITABLE COVERAGE
CRITERIA
CRITICAL ACCESS HOSPITAL
CROSSWALKING
CURRENT DENTAL TERMINOLOGY
CURRENT PROCEDURAL TERMINOLOGY
CUSTODIAL CARE
CUSTODIAN

D
D-CODES
DATA CONDITION
DATA CONTENT
DATA COUNCIL
DATA DICTIONARY
DATA ELEMENT
DATA EXTRACT SYSTEM ACCESS FORM
DATA INTERCHANGE STANDARDS ASSOCIATION
DATA MAPPING
DATA MODEL
DATA SUPPORT ACCESS FACILITY ACCESS FORM
DATA USE AGREEMENT
DATA USE CHECKLIST
DATE OF FILING AND DATE OF SUBMISSION
DATE OF RECEIPT
DEDUCTIBLE (MEDICARE)
DEEMED
DEEMED STATUS
DEEMED WAGE CREDIT
DEEMING AUTHORITY
DEFICIENCY (NURSING HOME)
DEHYDRATION
DEMOGRAPHIC ASSUMPTIONS
DEMOGRAPHIC DATA
DEMONSTRATIONS
DENTAL CONTENT COMMITTEE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DERIVATIVE FILE
DESCRIPTOR
DESIGNATED CODE SET
DESIGNATED DATA CONTENT COMMITTEE OR DESIGNATED DCC
DESIGNATED STANDARD
DESIGNATED STANDARD MAINTENANCE ORGANIZATION
DETERMINATION
DIABETIC DURABLE MEDICAL EQUIPMENT
DIAGNOSIS-RELATED GROUPS
DIAGNOSIS
DIAGNOSIS CODE
DIALYSATE
DIALYSIS
DIALYSIS CENTER (RENAL)
DIALYSIS FACILITY (RENAL)
DIALYSIS STATION
DIETHYLSTILBESTROL (DES)
DIGITAL IMAGING AND COMMUNICATIONS IN MEDICINE
DIRECT DATA ENTRY
DISABILITY
DISABILITY INSURANCE
DISABLED ENROLLEE
DISCHARGE PLANNING
DISCLOSURE
DISCLOSURE HISTORY
DISCOUNT DRUG LIST
DISCRETIONARY SPENDING
DISENROLL
DISPROPORTIONATE SHARE HOSPITAL
DOWNCODE
DRAFT STANDARD FOR TRIAL USE
DRG CODING
DRUG TIERS
DUAL ELIGIBLES
DURABLE MEDICAL EQUIPMENT
DURABLE MEDICAL EQUIPMENT REGIONAL CARRIER (DMERC)
DURABLE POWER OF ATTORNEY

E
EARNINGS
ECONOMIC ASSUMPTIONS
ECONOMIC STABILIZATION PROGRAM
EDIT
EDI TRANSLATOR
EFFECTIVE
EFFECTIVE DATE
EFFICIENT
ELDERCARE
ELECTION
ELECTION PERIODS
ELECTRONIC COMMERCE
ELECTRONIC DATA INTERCHANGE
ELECTRONIC HEALTHCARE NETWORK ACCREDITATION COMMISSION
ELECTRONIC MEDIA CLAIMS
ELECTRONIC MEDIA QUESTIONNAIRE
ELECTRONIC REMITTANCE ADVICE
ELIGIBILITY
ELIGIBILITY or MEDICARE PART A
ELIGIBILITY or MEDICARE PART B
EMERGENCY CARE
EMERGENCY ROOM (HOSPITAL)
EMPLOYEE
EMPLOYER
EMPLOYER BULLETIN BOARD SERVICE
EMPLOYER GROUP HEALTH PLAN (GHP)
EMPLOYER IDENTIFIER
EMT-BASIC
EMT-INTERMEDIATE
EMT-PARAMEDIC
EMTALA (EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT)
ENCOUNTER DATA
END-STAGE RENAL DISEASE
END-STAGE RENAL DISEASE (ESRD)
END-STAGE RENAL DISEASE NETWORK
END STAGE RENAL DISEASE TREATMENT FACILITY
ENHANCED BENEFITS
ENROLL
ENROLLEE HOTLINES
ENROLLMENT
ENROLLMENT - PART A
ENROLLMENT FEE
ENROLLMENT PERIOD
ENTITY ASSETS
EPISODE
EPISODE OF CARE
EQRO ORGANIZATION
EQUIVALENCY REVIEW
ESRD ELIGIBILITY REQUIREMENTS
ESRD FACILITY
ESRD NETWORK
ESRD NETWORK ORGANIZATION
ESRD PATIENT
ESRD SERVICES
EVIDENCE
EVIDENCE OF FUNDING
EXCESS CHARGES
EXCLUSIONS (MEDICARE)
EXPEDITED APPEAL
EXPEDITED ORGANIZATION DETERMINATION
EXPENDITURE
EXPENSE
EXTENDED CARE SERVICES
EXTERNAL QUALITY REVIEW ORGANIZATION

F
FACILITY CHARGE
FALSE NEGATIVES
FALSE POSITIVES
FEDERALLY QUALIFIED HEALTH CENTER
FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
FEDERAL GENERAL REVENUES
FEDERAL INSURANCE CONTRIBUTIONS ACT
FEDERAL INSURANCE CONTRIBUTION ACT PAYROLL TAX
FEDERAL MANAGERS' FINANCIAL INTEGRITY ACT
FEDERAL MEDICAL ASSISTANCE PERCENTAGE
FEDERAL REGISTER
FEE-FOR-SERVICES
FEE-SCREEN YEAR
FEE SCHEDULE
FINANCIAL DATA
FINANCIAL INTERCHANGE
FIRST RESPONDER
FISCAL INTERMEDIARY
FISCAL YEAR
FIXED CAPITAL ASSETS
FLAT FILE
FOCUSED STUDIES
FORMAT
FORMULARY
FORMULARY DRUGS
FRAUD
FRAUD AND ABUSE
FREEDOM OF INFORMATION ACT
FREEDOM OF INFORMATION ACT (FOIA)
FREE LOOK (MEDIGAP POLICY)
FREQUENCY DISTRIBUTION
FULLY ACCREDITED
FULL CAPITATION
FULL CAPITATION (FUL)
FULL PSC OR FULL PROGRAM SAFEGUARD CONTRACTOR

G
GAPFILLING
GAPS
GATEKEEPER
GENERAL ENROLLMENT PERIOD (GEP)
GENERAL FUND OF THE TREASURY
GENERAL REVENUE
GRIEVANCES AND COMPLAINTS
GROSS DOMESTIC PRODUCT
GROUP HEALTH PLAN
GROUP OR NETWORK HMO
GUARANTEED ISSUE RIGHTS (ALSO CALLED MEDIGAP PROTECTIONS)
GUARANTEED RENEWABLE
GUIDELINES

H
HCFA-1450
HCFA-1500
HEALTHCARE COMMON PROCEDURAL CODING SYSTEM
HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION
HEALTHCARE PROVIDER TAXONOMY CODES
HEALTH CARE CLEARINGHOUSE
HEALTH CARE CODE MAINTENANCE COMMITTEE
HEALTH CARE FINANCING ADMINISTRATION DATA MA
HEALTH CARE PREPAYMENT PLAN
HEALTH CARE PROVIDER
HEALTH CARE PROVIDER TAXONOMY COMMITTEE
HEALTH CARE QUALITY IMPROVEMENT PROGRAM
HEALTH EMPLOYER DATA AND INFORMATION SET (HEDIS)
HEALTH INFORMATICS STANDARDS BOARD
HEALTH INSURANCE ASSOCIATION OF AMERICA
HEALTH INSURANCE CLAIMS NUMBER
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996
HEALTH INSURING ORGANIZATION
HEALTH LEVEL SEVEN
HEALTH MAINTENANCE ORGANIZATIONS (HMO)
HEALTH PLAN
HEARING
HEDIS MEASURES FROM ENCOUNTER DATA
HEMATOCRIT
HEMODIAFILTRATION
HEMODIALYSIS
HEMODIALYSIS (HD)
HEMOFILTRATION
HIGH COST ALTERNATIVE
HIGH RISK AREA
HIPAA DATA DICTIONARY OR HIPAA DD
HOME
HOMEBOUND
HOME AND COMMUNITY-BASED SERVICE WAIVER PROGRAMS (HCBS)
HOME HEALTH AGENCY
HOME HEALTH CARE
HOME PATIENTS
HOSPICE
HOSPICE CARE
HOSPITAL-INPUT-PRICE
HOSPITALIST
HOSPITAL ASSUMPTIONS
HOSPITAL COINSURANCE
HOSPITAL INDEMNITY INSURANCE
HOSPITAL INSURANCE
HOSPITAL INSURANCE (PART A)
HOSPITAL MARKET BASKET
HYBRID ENTITY
HYDRATION

I
ICD, ICD-N-CM, ICD-N-PCS
IMMUNOSUPPRESSIVE DRUGS
IMPLEMENTATION GUIDE
IMPLEMENTATION SPECIFICATION
IMPROVEMENT PLAN
INAPPROPRIATE UTILIZATION
INCIDENCE
INCOME RATE
INCURRED BASIS
INDEPENDENT LABORATORY
INDICATOR
INFORMATION, COUNSELING, AND ASSISTANCE PROGRAM
INFORMATION MODEL
INFUSION PUMPS
INITIAL (CLAIM) DETERMINATION
INITIAL COVERAGE ELECTION PERIOD
INITIAL ENROLLMENT PERIOD
INITIAL ENROLLMENT QUESTIONNAIRE (IEQ)
INPATIENT CARE
INPATIENT HOSPITAL
INPATIENT HOSPITAL DEDUCTIBLE
INPATIENT HOSPITAL SERVICES
INPATIENT PSYCHIATRIC FACILITY
INSOLVENCY
INSURER
INTEREST
INTERFUND BORROWING
INTERMEDIARY
INTERMEDIARY HEARING
INTERMEDIARY OR PROGRAM SAFEGUARD CONTRACTOR DETERMINATION
INTERMEDIATE CARE FACILITY OR MENTALLY RETARDED
INTERMEDIATE ENTITIES
INTERMITTENT PERITONEAL DIALYSIS
INTERNAL CONTROLS
INTERNAL REVENUE SERVICE
INTERNATIONAL CLASSIFICATION OF DISEASES
INTERNATIONAL ORGANIZATION FOR STANDARDIZATION
INTERNIST
INTER OR INTRA AGENCY AGREEMENT
INTRAGOVERNMENTAL ASSETS, LIABILITIES

J
J-CODES
JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS

L
LARGE GROUP HEALTH PLAN
LETTER OF REQUEST
LETTER OF SUPPORT
LIABILITY DETERMINATION
LIABILITY INSURANCE
LICENSED (LICENSURE)
LICENSED BY THE STATE AS A RISK-BEARING ENTITY
LIFETIME RESERVE DAYS
LIFETIME RESERVE DAYS (MEDICARE)
LIMITING CHARGE
LINE ITEM
LIVING DONOR KIDNEY TRANSPLANT
LIVING WILLS
LMRP ARTICLES
LOCAL CODE(S)
LOCAL CODES
LOCAL COVERAGE DETERMINATION (LCD)
LOCAL MEDICAL REVIEW POLICY (LMRP)
LOGICAL OBSERVATION IDENTIFIERS, NAMES AND CODES
LONG-TERM CARE
LONG-TERM CARE INSURANCE
LONG-TERM CARE OMBUDSMAN
LONGER TERM CARE MINIMUM DATA SET
LONG RANGE
LOOP
LOW COST ALTERNATIVE

M
MALNUTRITION
MAMMOGRAM
MANAGED CARE
MANAGED CARE ORGANIZATION
MANAGED CARE PAYMENT SUSPENSION
MANAGED CARE PLAN
MANAGED CARE PLAN WITH A POINT OF SERVICE OPTION (POS)
MANAGED CARE SYSTEM
MANDATORY SPENDING
MANDATORY SUPPLEMENTAL BENEFITS
MANUAL CLAIM REVIEW
MANUAL TRANSMITTALS
MARKET BASKET
MASS IMMUNIZATION CENTER
MATERIAL WEAKNESS
MAXIMUM DEFINED DATA SET
MAXIMUM ENROLLEE OUT-OF-POCKET COSTS
MAXIMUM PLAN BENEFIT COVERAGE
MAXIMUM TAXABLE AMOUNT OF ANNUAL EARNINGS
MAXIMUM TAX BASE
MCO OR PHP STANDARDS
MEASUREMENT
MEDIATE
MEDICAID-ONLY MCO
MEDICAID
MEDICAID MANAGEMENT INFORMATION SYSTEM
MEDICAID MCO
MEDICALLY NECESSARY
MEDICAL BILLING
MEDICAL BILLING AND CODING JOBS
MEDICAL CODE SETS
MEDICAL CODING
MEDICAL INSURANCE (PART B)
MEDICAL RECORDS INSTITUTE
MEDICAL REVIEW OR UTILIZATION REVIEW
MEDICAL UNDERWRITING
MEDICARE-APPROVED AMOUNT
MEDICARE-ECONOMIC
MEDICARE
MEDICARE ADVANTAGE PLAN
MEDICARE BENEFITS
MEDICARE BENEFITS NOTICE
MEDICARE CARRIER
MEDICARE CONTRACTOR
MEDICARE COORDINATION OF BENEFITS CONTRACTOR
MEDICARE COVERAGE
MEDICARE COVERAGE ADVISORY COMMITTEE (MCAC)
MEDICARE DURABLE MEDICAL EQUIPMENT REGIONAL CARRIER
MEDICARE HANDBOOK
MEDICARE MANAGED CARE PLAN
MEDICARE MEDICAL SAVINGS ACCOUNT PLAN (MSA)
MEDICARE NATIONAL COVERAGE DETERMINATIONS MANUAL
MEDICARE PART A (HOSPITAL INSURANCE)
MEDICARE PART A FISCAL INTERMEDIARY
MEDICARE PART B (MEDICAL INSURANCE)
MEDICARE PART B CARRIER
MEDICARE PART B PREMIUM REDUCTION AMOUNT
MEDICARE PAYMENT ADVISORY COMMISSION
MEDICARE+CHOICE
MEDICARE+CHOICE PLAN
MEDICARE PREFERRED PROVIDER ORGANIZATION (PPO) PLAN
MEDICARE PREMIUM COLLECTION CENTER (MPCC)
MEDICARE PRIVATE FEE-FOR-SERVICE PLAN
MEDICARE REMITTANCE ADVICE REMARK CODES
MEDICARE SAVINGS PROGRAM
MEDICARE SAVINGS PROGRAMS
MEDICARE SECONDARY PAYER
MEDICARE SELECT
MEDICARE SUMMARY NOTICE (MSN)
MEDICARE SUPPLEMENT INSURANCE
MEDICARE TRUST FUNDS
MEDIGAP POLICY
MEMORANDUM OF UNDERSTANDING
MILITARY SERVICE WAGE CREDITS
MILITARY TREATMENT FACILITY
MINIMUM SCOPE OF DISCLOSURE
MODALITY
MODIFIED AVERAGE-COST METHOD
MODIFY OR MODIFICATION
MONITORING
MONITORING OF MCO OR PHP STANDARDS
MORBIDITY
MORBIDITY RATE
MORTALITY RATE
MULTI-EMPLOYER GROUP HEALTH PLAN
MULTI-EMPLOYER PLAN
MULTIPLE EMPLOYER PLAN
M+C ORGANIZATION (MEDICARE+CHOICE)
M+C PLAN

N
NATIONAL ASSOCIATION OF HEALTH DATA ORGANIZATIONS
NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS
NATIONAL ASSOCIATION OF STATE MEDICAID DIRECTORS
NATIONAL CENTER FOR HEALTH STATISTICS
NATIONAL COMMITTEE FOR QUALITY ASSURANCE
NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA)
NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS
NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS
NATIONAL COVERAGE ANALYSES (NCA)
NATIONAL COVERAGE DETERMINATIONS (NCDS)
NATIONAL COVERAGE POLICY
NATIONAL DRUG CODE
NATIONAL EMPLOYER ID
NATIONAL HEALTH INFORMATION INFRASTRUCTURE
NATIONAL IMPROVEMENT PROJECTS
NATIONAL MEDIAN CHARGE
NATIONAL PATIENT ID
NATIONAL PAYER ID
NATIONAL PROVIDER FILE
NATIONAL PROVIDER IDENTIFIER
NATIONAL PROVIDER REGISTRY
NATIONAL PROVIDER SYSTEM
NATIONAL STANDARD FORMAT
NATIONAL STANDARD PER VISIT RATES
NATIONAL UNIFORM BILLING COMMITTEE
NATIONAL UNIFORM CLAIM COMMITTEE
NCPDP BATCH STANDARD
NCPDP TELECOMMUNICATION STANDARD
NEBULIZERS
NEGLECT
NETWORK
NO-FAULT INSURANCE
NON-COVERED SERVICE
NON-ENTITY ASSETS
NON-FEDERAL AGENCY
NON-FORMULARY DRUGS
NONCONTRIBUTORY OR DEEMED WAGE CREDITS
NONPARTICIPATING PHYSICIAN
NORTH CAROLINA HEALTHCARE INFORMATION AND COMMUNICATIONS ALLIANCE
NOTICE OF INTENT
NOTICE OF PROPOSED RULEMAKING
NPLANID
NUBC EDI TAG
NURSE PRACTITIONER
NURSING FACILITY
NURSING HOME
NUTRITION

O
OBLIGATION
OCCUPATIONAL THERAPY
OFFICE
OFFICE FOR CIVIL RIGHTS
OFFICE OF MANAGEMENT & BUDGET
OFFSET
OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE
OMBUDSMAN
ON-SITE REVIEWS
OPEN ENROLLMENT PERIOD
OPEN SYSTEM INTERCONNECTION
OPTIONAL SUPPLEMENTAL BENEFITS
ORGAN
ORGANIZATIONAL DETERMINATION
ORGAN PROCUREMENT
ORGAN PROCUREMENT ORGANIZATION
ORIGINAL MEDICARE PLAN
OTHER MANAGED CARE ARRANGEMENT
OTHER UNLISTED FACILITY
OUT-OF-POCKET COSTS
OUTCOME
OUTCOME AND ASSESSMENT INFORMATION SET
OUTCOME DATA
OUTCOME INDICATOR
OUTLAY
OUTLIER
OUTPATIENT CARE
OUTPATIENT HOSPITAL
OUTPATIENT HOSPITAL SERVICES (MEDICARE)
OUTPATIENT PROSPECTIVE PAYMENT SYSTEM
OUTPATIENT SERVICES
OUT OF AREA
OUT OF NETWORK BENEFIT
OVERPAYMENT ASSESSMENT

P
PANEL SIZE
PAP TEST
PARTIALLY CAPITATED
PARTIAL CAPITATION
PARTIAL HOSPITALIZATION
PARTICIPATING HOSPITALS
PARTICIPATING PHYSICIAN OR SUPPLIER
PART A (HOSPITAL INSURANCE)
PART A (MEDICARE)
PART A OF MEDICARE
PART A PREMIUM
PART B (MEDICAL INSURANCE)
PART B (MEDICARE)
PART B OF MEDICARE
PATIENT ADVOCATE
PATIENT LIFTS
PATTERN ANALYSIS
PAY-AS-YOU-GO FINANCING
PAYER
PAYERID
PAYMENT
PAYMENT RATE
PAYMENT SAFEGUARDS
PAYMENT SUSPENSION
PAYROLL TAXES
PELVIC EXAM
PERCENTILE
PERFORMANCE
PERFORMANCE ASSESSMENT
PERFORMANCE IMPROVEMENT PROJECTS
PERFORMANCE MEASURE
PERFORMANCE MEASURES
PERIODS OF CARE (HOSPICE)
PERITONEAL DIALYSIS
PERITONEAL DIALYSIS (PD)
PERSONAL CARE
PHYSICAL THERAPY
PHYSICIAN ASSISTANT (PA)
PHYSICIAN GROUP
PHYSICIAN INCENTIVE PLAN
PHYSICIAN SERVICES
PLAN ID
PLAN OF CARE
PLAN SPONSOR
POINT-OF-SERVICE (POS)
POINT OF SERVICE (POS)
POLICY ADVISORY GROUP
POSTPAYMENT REVIEW
POTENTIAL FRAUD CASE
POTENTIAL PAYMENTS
POWER OF ATTORNEY
PRE-EXISTING CONDITION
PREFERRED PROVIDER ORGANIZATION
PREFERRED PROVIDER ORGANIZATION (PPO)
PREFERRED PROVIDER ORGANIZATION (PPO) PLAN
PREMIUM SURCHARGE
PREPAID HEALTH PLAN
PREPAYMENT REVIEW
PRESENT VALUE
PREVALENCE
PREVENTIVE SERVICES
PRICER
PRICER OR REPRICER
PRIMARY CARE
PRIMARY CARE CASE MANAGEMENT PROVIDER
PRIMARY CARE DOCTOR
PRIMARY CASE MANAGEMENT
PRIMARY PAYER
PRIVACY ACT OF 1974
PRIVATE CONTRACT
PRIVATE FEE-FOR-SERVICE PLAN
PROCEDURE
PROCESS
PROCESS IMPROVEMENT
PROCESS INDICATOR
PRODUCTIVITY INVESTMENTS
PROFILES
PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
PROGRAM MANAGEMENT
PROGRAM MANAGEMENT AND MEDICAL INFORMATION SYSTEM
PROGRAM SAFEGUARD CONTRACTOR
PROJECTION ERROR
PROJECT OFFICER
PROSPECTIVE PAYMENT SYSTEM
PROS AND CONS
PROTECTED HEALTH INFORMATION
PROVIDER
PROVIDER NETWORK
PROVIDER SPONSORED ORGANIZATION (PSO)
PROVIDER SURVEY DATA
PROVIDER TAXONOMY CODES
PROXY
PSYCHIATRIC FACILITY (PARTIAL HOSPITALIZATION)
PSYCHIATRIC RESIDENTIAL TREATMENT CENTER
PUBLIC USE FILE
PURCHASE ORDER

Q
QUALIFIED MEDICARE BENEFICIARY (QMB)
QUALIFYING INDIVIDUALS (1) (QI-1S)
QUALIFYING INDIVIDUALS (2) (QI-2S)
QUALITY
QUALITY ASSURANCE
QUALITY IMPROVEMENT ORGANIZATION
QUINQUENNIAL MILITARY SERVICE DETERMINATION AND ADJUSTMENTS

R
RAILROAD RETIREMENT
RANDOM SAMPLE
REAL-WAGE DIFFERENTIAL
REASONABLE-COST BASIS
REASONABLE COST
RECIPIENT
RECOUPMENT
REFERRAL
REFERRAL SERVICES
REGENSTRIEF INSTITUTE
REGIONAL HOME HEALTH INTERMEDIARY (RHHI)
REGIONAL OFFICE
REHABILITATION
REHABILITATION (AS DISTINGUISHED FROM VOCATIONAL REHABILITATION)
REJECT STATUS
RENAL TRANSPLANT CENTER
REOPENING
REPORT CARD
REQUESTOR
RERELEASE
RESEARCH DATA ASSISTANCE CENTER
RESEARCH PROTOCOL
RESERVE DAYS
RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITY
RESIDUAL FACTORS
RESOURCE-BASED RELATIVE VALUE SCALE
RESPITE CARE
RESTRAINTS
REUSE
REVENUE
REVENUE CODE
REVIEW OF CLAIMS
RIGHTS OF INDIVIDUALS
RISK-BASED HEALTH MAINTENANCE ORGANIZATION OR COMPETITIVE MEDICAL PLAN
RISK ADJUSTMENT
ROUTINE USE
RURAL HEALTH CLINIC

S
SANCTIONS
SECONDARY PAYER
SECOND OPINION
SECRETARY
SEER - MEDICARE DATABASE
SEER PROGRAM
SEGMENT
SELF-EMPLOYMENT
SELF-EMPLOYMENT CONTRIBUTION ACT PAYROLL TAX
SELF-INSURED
SELF DIALYSIS
SEQUESTER
SERVICE
SERVICE AREA
SERVICE AREA (PRIVATE FEE-FOR-SERVICE)
SERVICE CATEGORY DEFINITION
SHORT RANGE
SIDE EFFECT
SINGLE DRUG PRICER
SKILLED CARE
SKILLED NURSING CARE
SKILLED NURSING FACILITY
SKILLED NURSING FACILITY (SNF)
SKILLED NURSING FACILITY CARE
SMALL HEALTH PLAN
SMI PREMIUM
SNF COINSURANCE
SOCIAL HEALTH MAINTENANCE ORGANIZATION (SHMO)
SOCIAL SECURITY ACT
SOCIAL SECURITY ADMINISTRATION
SPECIALIST
SPECIALTY CONTRACTOR
SPECIALTY PLAN
SPECIAL ELECTION PERIOD
SPECIAL ENROLLMENT PERIOD
SPECIAL PUBLIC-DEBT OBLIGATION
SPECIFIED DISEASE INSURANCE
SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES (SLMB)
SPEECH-LANGUAGE THERAPY
SPELL OF ILLNESS
STAFF ASSISTED DIALYSIS
STANDARD CLAIMS PROCESSING SYSTEM
STANDARD TRANSACTION
STATE CERTIFICATION
STATE CHILDRENS HEALTH INSURANCE PROGRAM
STATE HEALTH INSURANCE ASSISTANCE PROGRAM
STATE INSURANCE DEPARTMENT
STATE LAW
STATE LICENSURE AGENCY
STATE MEDICAL ASSISTANCE OFFICE
STATE OR LOCAL PUBLIC HEALTH CLINIC
STATE SURVEY
STATE SURVEY AGENCY
STATE UNIFORM BILLING COMMITTEE
STATUS LOCATION
STOCHASTIC MODEL
STRATEGIC NATIONAL IMPLEMENTATION PROCESS
SUBSIDIZED SENIOR HOUSING
SUBSTANTIAL FINANCIAL RISK
SUMMARIZED COST RATE
SUMMARIZED INCOME RATE
SUPPLEMENTAL EDIT SOFTWARE
SUPPLEMENTARY MEDICAL INSURANCE
SUPPLIER
SURVEY AND CERTIFICATION PROCESS
SUSPENSION OF PAYMENTS
SUSTAINABLE GROWTH RATE
SYNTAX
SYSTEMATIC
SYSTEM NOTICE
SYSTEM OF RECORDS

T
TAXABLE EARNINGS
TAXABLE PAYROLL
TAXABLE SELF-EMPLOYMENT INCOME
TAXABLE WAGES
TAXATION OF BENEFITS
TAXES
TAX AND DONATIONS
TAX RATE
TECHNOLOGY ASSESSMENT (TA)
TELEMEDICINE
TERM INSURANCE
TEST OF LONG-RANGE CLOSE ACTUARIAL BALANCE
TEST OF SHORT-RANGE FINANCIAL ADEQUACY
THIRD PARTY ADMINISTRATOR
THIRD PARTY USE
TIER
TRADING PARTNER
TRANSACTION
TRANSACTION CHANGE REQUEST SYSTEM
TRANSIENT PATIENTS
TRANSPLANT
TRAUMA CODE DEVELOPMENT
TREATMENT
TREATMENT OPTIONS
TRICARE
TRICARE FOR LIFE (TFL)
TRUE NEGATIVES
TRUST FUND
TRUST FUND RATIO
TTY

U
UB-82
UB-92
UNASSIGNED CLAIM
UNIFORM CLAIM TASK FORCE
UNITED NATIONS CENTRE FOR FACILITATION OF PROCEDURES AND PRACTICES FOR ADMINISTRATION, COMMERCE, AND
UNITED NATIONS RULES FOR ELECTRONIC DATA INTERCHANGE FOR ADMINISTRATION, COMMERCE, AND TRANSPORT
UNIT INPUT INTENSITY ALLOWANCE
URGENTLY NEEDED CARE
UTAH HEALTH INFORMATION NETWORK
UTILIZATION SUMMARY DATA

V
VALIDATION
VALUATION PERIOD
VALUE-ADDED NETWORK
VIRTUAL PRIVATE NETWORK
VOCATIONAL REHABILITATION
VOLUNTARY AGREEMENT
VOLUNTARY ENROLLEE

W
WAITING PERIOD
WASHINGTON PUBLISHING COMPANY
WITHHOLD
WORKERS COMPENSATION
WORKFORCE
WORKGROUP FOR ELECTRONIC DATA INTERCHANGE
WORLD HEALTH ORGANIZATION

X
X12
X12F
X12J
X12N
X12N OR SPTG4
X12N OR TG1
X12N OR TG2
X12N OR TG2 OR WG1
X12N OR TG2 OR WG12
X12N OR TG2 OR WG15
X12N OR TG2 OR WG19
X12N OR TG2 OR WG2
X12N OR TG2 OR WG3
X12N OR TG2 OR WG4
X12N OR TG2 OR WG5
X12N OR TG2 OR WG9
X12N OR TG3
X12N OR TG3 OR WG1
X12N OR TG3 OR WG21
X12N OR TG3 OR WG3
X12N OR TG3 OR WG4
X12N OR TG4
X12N OR TG8
X12N TG2 WG10
X12 148
X12 270
X12 271
X12 274
X12 275
X12 276
X12 277
X12 278
X12 811
X12 820
X12 831
X12 834
X12 835
X12 837
X12 997
X12 IHCEBI & IHCEBR
X12 IHCLME
X12 OR PRB
X12 STANDARD

Y
YEAR OF EXHAUSTION

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