Healthcare Abbreviations & Acronyms
Explore our guide to common medical abbreviations and acronyms, a helpful tool for understanding healthcare terms.
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The Affordable Care Act (ACA) is a federal law enacted in the United States to expand access to healthcare coverage, improve healthcare…
An Acute Care Hospital (ACH) is a medical facility that provides short-term and immediate care for patients with severe injuries or illnesses.
An Accountable Care Organization (ACO) is a healthcare delivery model in which a group of healthcare providers, such as hospitals, physicians, and…
An Accountable Care System (ACS) is a regional or local healthcare network that integrates various healthcare organizations, providers, and services to deliver…
Admit / Discharge / Transfer (ADT) refers to the process of tracking and managing patient movements within a healthcare facility, including admissions,…
Average Length of Stay (ALOS) is a metric that measures the average duration of time patients spend in a hospital or healthcare…
The American Medical Association (AMA) is a professional organization that represents physicians and medical students in the United States. The AMA plays…
Acute Myocardial Infarction (AMI), commonly known as a heart attack, occurs when there is a sudden blockage of blood flow to a…
Ambulatory Payment Classification (APC) is a system used by the Centers for Medicare and Medicaid Services (CMS) to determine the payment rates…
Advanced Alternative Payment Model (APM) is a payment model that provides financial incentives for healthcare providers to deliver high-quality, cost-effective care. APMs…
An Ambulatory Surgical Center (ASC) is a healthcare facility that specializes in performing outpatient surgical procedures. ASCs provide a convenient and cost-effective…
A Beneficiary Advisory Committee (BAC) is a committee or group of individuals who represent the interests and perspectives of healthcare beneficiaries, such…
Bundled Payments for Care Improvement (BPC) is an initiative introduced by the Centers for Medicare and Medicaid Services (CMS) to promote coordinated…
The Bundled Payments for Care Improvement (BPCI) Initiative is a CMS program that tests alternative payment models for specific episodes of care.
In the context of healthcare, BUCAH refers to the collective group of the United States’ five largest health insurance providers: Blue Cross,…
Coronary Artery Bypass Graft (CABG) is a surgical procedure that restores blood flow to the heart by bypassing blocked or narrowed coronary…
Coronary Artery Disease (CAD) is a condition characterized by the narrowing or blockage of the coronary arteries that supply blood to the…
A Critical Access Hospital (CAH) is a small rural hospital that receives special designation and reimbursement under Medicare. CAHs play a critical…
A CMS Certification Number (CCN), also known as a Medicare Provider Number, is a unique identification number assigned by the Centers for…
A Coronary Care Unit (CCU) is a specialized hospital unit that provides intensive care and monitoring for patients with acute cardiac conditions,…
The Chronic Condition Warehouse (CCW) is a comprehensive database developed by the Centers for Medicare & Medicaid Services (CMS) that contains Medicare…
The Chronic Illness and Disability Payment System (CDPS) is a payment model used by some Medicare Advantage plans to adjust payments based…
Comprehensive ESRD (End-Stage Renal Disease) Care is a program established by the Centers for Medicare & Medicaid Services to improve the care…
Congestive Heart Failure (CHF) is a chronic condition in which the heart is unable to pump blood efficiently, leading to fluid buildup…
A Community Health Information Network (CHIN) is a collaboration of healthcare organizations, providers, and stakeholders within a community or region to exchange…
The Children’s Health Insurance Program (CHIP) is a government-funded program in the United States that provides low-cost or free health insurance coverage…
Comprehensive Care for Joint Replacement (CJR) is a bundled payment model introduced by CMS to improve the quality and efficiency of care…
A Case Mix Group (CMG) is a classification system used in healthcare to group patients with similar clinical and resource utilization characteristics.
Case Mix Index (CMI) is a measure used to assess the average severity or complexity of a hospital’s patient population. It quantifies…
The Center for Medicare & Medicaid Innovation (CMMI) is an agency within CMS responsible for testing and implementing innovative payment and service…
Within the context of healthcare, Centers for Medicare & Medicaid Services (CMS) refers to the federal agency within the United States Department…
A Center of Excellence (COE) in healthcare is a specialized program within a healthcare institution that provides exceptionally high-quality care and expertise…
Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by chronic inflammation, airflow limitation, and breathing difficulties. COPD includes conditions…
Clinical Practice Guidelines (CPGs) are evidence-based recommendations developed by healthcare experts to guide healthcare professionals in making informed decisions about patient care.
Current Procedural Terminology (CPT) is a standardized coding system developed and maintained by the American Medical Association (AMA) to describe medical, surgical,…
The Department of Medical Assistance Services (DMAS) is a state agency that administers Medicaid and other publicly funded healthcare programs in a…
Durable Medical Equipment (DME) refers to reusable medical devices, equipment, or supplies prescribed by a healthcare provider to assist with the treatment,…
The Date of Fill (DOF) refers to the date when a prescription medication is filled and dispensed to a patient by a…
The Date of Service (DOS) refers to the date when a specific healthcare service or procedure was provided to a patient. DOS…
Diagnostic Related Grouping (DRG) is a system used in healthcare to classify inpatient hospital cases into groups based on similar clinical characteristics…
A Disproportionate Share Hospital (DSH) is a healthcare facility that serves a significantly high number of low-income and uninsured patients compared to…
Evidence-informed Case Rate (ECR) is a payment model used in healthcare that provides a fixed payment amount for the management of specific…
An Enrollment Data Base (EDB) is a repository or system that stores and manages data related to healthcare enrollment, such as information…
Episode Grouper for Medicare (EGM) is a software or tool used by Medicare to group together healthcare services and resources associated with…
An Electronic Health Record (EHR) is a digital version of a patient’s comprehensive medical history, including diagnoses, treatments, medications, laboratory results, and…
Episode Initiators (EI) refer to the events, conditions, or procedures that trigger the start of an episode of care or treatment under…
An Electronic Medical Record (EMR) is a digital version of a patient’s medical record, containing information about their medical history, diagnoses, treatments,…
Episode Payment Models (EPMs) are payment models that provide a single bundled payment for all healthcare services related to an episode of…
End-Stage Renal Disease (ESRD) refers to the final stage of kidney disease, in which the kidneys can no longer perform their vital…
Fee-for-Service (FFS) is a payment model in healthcare where providers are reimbursed based on the quantity of services delivered. Providers are paid…
Fast Healthcare Interoperability Resources (FHIR) is a standard for exchanging healthcare information electronically. FHIR uses modern web technologies and data formats to…
A Federally Qualified Health Center (FQHC) is a community-based healthcare facility that receives federal funding to provide comprehensive primary care services to…
Hospital Acquired Conditions (HACs) refer to medical conditions or complications that patients develop during their hospital stay but were not present or…
A Hospital Acquired Infection (HAI), also known as a Hospital Associated Infection, is an infection that a patient acquires during their hospital…
A Hospital-Based Physician (HBP) refers to a physician who primarily practices medicine within a hospital setting. HBPs are typically involved in providing…
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey tool used to measure patients’ perspectives on the…
Hierarchical Condition Categories (HCCs) is a risk adjustment model used to predict the healthcare costs and resource utilization of Medicare Advantage beneficiaries.
The Healthcare Common Procedure Coding System (HCPCS) is a coding system used to describe and report medical procedures, supplies, and services provided…
The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures developed by the National Committee for Quality…
A Home Health Agency (HHA) is a healthcare organization that provides skilled nursing care, therapy services, and other supportive care to individuals…
The Department of Health & Human Services (HHS) is a federal agency in the United States responsible for protecting and promoting the…
Health Information Exchange (HIE) refers to the electronic sharing of patient health information across different healthcare organizations and systems. HIE allows for…
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law in the United States that sets standards for the protection…
The Health Insurance Prospective Payment System (HIPPS) is a payment methodology used in the United States for reimbursing skilled nursing facilities (SNFs)…
Hospital Inpatient Quality Reporting (HIQR) is a program implemented by CMS to assess and publicly report the quality of care provided by…
The Health Information Trust Alliance (HITRUST) is an organization that provides a common security framework and certification program for healthcare organizations and…
Health Level Seven (HL7) is an international standards organization that develops and promotes standards for the exchange, integration, sharing, and retrieval of…
The Hip Disability and Osteoarthritis Outcome Score (HOOS) is a validated questionnaire used to assess the functional status and quality of life…
A Hospital Outpatient Department (OPD) is a unit within a hospital that provides medical services to patients who do not require overnight…
HOS refers to a survey that measures patient health outcomes to ensure quality and effectiveness in healthcare services.
HPI is a detailed record of the symptoms and conditions leading to the current illness or health problem of a patient.
HRR is a geographical area that characterizes healthcare markets, showing where patients are referred for major cardiovascular surgical procedures and neurosurgery.
The Hospital Readmissions Reductions Program (HRRP) is a program that aims to reduce hospital readmissions by financially penalizing hospitals with higher-than-expected readmission…
The Health Service System (HSS) is a system that provides comprehensive health services, including medical, dental, and behavioral health care, to eligible…
The Hospital Value-Based Purchasing Program (HVBP) is a program that incentivizes hospitals based on their performance in quality measures, patient experience, and…
The International Classification of Diseases (ICD) is a standardized system of codes used for the classification and coding of diseases, injuries, and…
An Internal Control Number (ICN) is a unique identification number assigned to each Medicare claim to track and process payment for services…
An Intensive Care Unit (ICU) is a specialized unit within a hospital that provides advanced medical care and continuous monitoring for critically…
An Integrated Data Repository (IDR) is a centralized database that consolidates and stores various types of healthcare-related data, such as clinical, financial,…
The Institute for Healthcare Improvement (IHI) is a nonprofit organization that promotes and implements evidence-based practices and quality improvement initiatives to enhance…
Indirect Medical Education (IME) is a payment adjustment made to teaching hospitals to account for the additional costs associated with training medical…
An Information Network Project (INP) is a collaborative project that aims to establish an integrated information network, typically within a healthcare system…
An Inpatient Psychiatric Facility (IPF) is a specialized facility that provides diagnostic, therapeutic, and rehabilitative services for individuals with severe mental health…
An Inpatient Prospective Payment System (IPPS) is a payment system used by Medicare to reimburse hospitals for inpatient services based on a…
An Inpatient Quality Reporting (IQR) is a program that requires hospitals to report on various quality measures and submit data to Medicare,…
An Inpatient Rehabilitation Facility (IRF) is a facility that provides intensive rehabilitative services, including physical therapy, occupational therapy, and speech therapy, to…
The Kaiser Family Foundation (KFF) is a nonprofit organization that provides information, analysis, and research on healthcare issues, health policy, and health-related…
A Knee Injury and Osteoarthritis Outcome Score (KOOS) is a standardized assessment tool used to evaluate the outcomes and functional status of…
A Lower-Extremity Joint Replacement (LEJR) is a surgical procedure involving the replacement of a joint in the lower extremities, such as the…
Low-Income Patients (LIP) are individuals or patients who have limited financial resources and fall within a designated income threshold, often qualifying them…
Length of Stay (LOS) is the duration of time a patient spends in a healthcare facility, typically measured from admission to discharge,…
A Licensed Practical Nurse (LPN) is a healthcare professional who has completed a practical nursing program and is licensed to provide basic…
Lifetime Reserve Days (LDRs) are additional days that Medicare will pay for when you’re in a hospital for more than 90 days.
A Long-Term Care Hospital (LTCH) is a hospital that specializes in treating patients who may have more than one serious condition, but…
Low Utilization Payment Adjustment (LUPA) refers to a payment adjustment under the Medicare home health prospective payment system that applies when a…
Medicare Advantage (MA) is a type of health insurance that provides Medicare benefits through a private-sector health insurer. MAPD is a Medicare…
A Medicare Administrative Contractor (MAC) is a private healthcare insurer that has been awarded a geographic jurisdiction to process Medicare Part A…
Medicare and CHIP Reconciliation Act (MACRA) is a federal legislation that established new ways to pay physicians for caring for Medicare beneficiaries,…
Medicaid Analytic Extract (MAX) is a set of files containing Medicaid enrollee information, including demographic characteristics, eligibility, and claims data.
Master Beneficiary Summary File (MBSF) is a database that includes a comprehensive set of beneficiary-level, claim-level, and assessment-level data for individuals enrolled…
Major Complications or Comorbidities (MCC) refer to secondary diagnoses that significantly complicate a patient’s primary condition and increase the resources needed to…
A Managed Care Organization (MCO) is a type of health insurance where a company contracts with a network of providers to deliver…
A Medicaid Managed Care Plan (MCP) is a health care plan in which Medicaid recipients receive most or all of their care…
Major Diagnostic Categories (MDCs) are groups of diagnoses that have similar clinical characteristics and similar levels of resource use.
Medicare Drug Integrity Contractors (MEDICs) are entities contracted by CMS to detect and prevent fraud, waste, and abuse in the Medicare Part…
Merit-Based Incentive Payment System (MIPS) is a payment mechanism that provides adjustments to eligible clinicians based on evidence-based and practice-specific quality data.
Maximum Out of Pocket (MOOP) is the most you have to pay for covered services in a plan year. After you spend…
Machine-Readable File (MRF) refers to digital documents or datasets formatted for easy processing and interpretation by computer systems. These files are integral…
Medicare Severity Diagnosis Related Groups (MS-DRGs) are a classification system that groups patients with similar clinical problems that are expected to consume…
Management Services Organizations (MSOs) in healthcare are entities that provide non-clinical administrative services to healthcare providers or practices. MSOs enable physicians and…
Medicare Spending Per Beneficiary (MSPB) measures the cost to Medicare for services performed by an individual hospital compared to the national median…
Non-claims Based Payments (NCBPs) are payments made to providers that aren’t based on individual claims for services, such as capitated payments or…
National Drug Code (NDC) is a unique product identifier used in the United States for drugs intended for human use.
The National Institutes of Health (NIH) is a part of the U.S. Department of Health and Human Services and is the nation’s…
In the context of healthcare, Natural Language Processing (NLP) refers to the use of computational techniques to analyze, understand, and generate human language data in medical records, clinical notes, and research articles.
National Provider Identifier (NPI) is a unique identification number for covered healthcare providers used in administrative and financial transactions under HIPAA.
Nonphysician Practitioner (NPP) refers to healthcare providers who are not physicians but who perform some of the same care typically provided by…
Net Payment Reconciliation Amount (NPRA) is the difference between a health plan’s target amount and the actual amount of healthcare expenses it…
Outcome and Assessment Information Set (OASIS) is a standardized assessment used in the home healthcare industry to collect data on patient characteristics,…
Oncology Care Mode (OCM) is a payment and delivery model that aims to provide higher quality, more highly coordinated oncology care at…
The Office of Management and Budget (OMB) is a federal agency that evaluates, formulates, and coordinates management procedures and program objectives within…
The Office of the National Coordinator for Health Information Technology (ONC) is a division of the Department of Health and Human Services…
Out of Pocket (OOP) refers to medical costs that are not covered by insurance and must be paid by the patient.
Outpatient Prospective Payment System (OPPS) is a system by which Medicare decides how much money a hospital or community mental health center…
Principal Accountable Provider (PAP) refers to the healthcare provider who is primarily responsible for coordinating the care of a patient.
Pharmacy Benefit Managers (PBMs) are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large…
Percutaneous Coronary Intervention (PC) is a non-surgical procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary…
PECOS is the online Medicare provider and supplier enrollment system. It allows providers and suppliers to enroll, make a change in their…
Physician Group Practice (PGP) refers to a healthcare provider organization in which physicians are organized around their collective capacity to deliver a…
Protected Health Information (PHI) is any information in a medical record that can be used to identify an individual, and that was…
Personal Health Records (PHR) is an electronic record of health-related information on an individual that can be managed, exchanged, and controlled by…
Personally Identifiable Information (PII) is any information that can be used to identify the identity of an individual or can be directly…
Per Member Per Month (PMPM) is a method of calculating healthcare costs based on the average monthly cost for each member of…
Per Member Per Year (PMPY) is a method of calculating healthcare costs based on the average yearly cost for each member of…
Present on Admission (POA) is a billing term that refers to conditions present when the patient was admitted to the hospital.
POC is a realization of a certain method or idea to demonstrate its feasibility, or a demonstration in principle, with the aim…
PPS is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for…
PROMIS is a system of measures of patient–reported health status for physical, mental, and social well–being.
PROMs are a type of patient-reported outcome measure that can be used in clinical practice to inform patient care or in clinical…
PROs are health outcomes directly reported by the patient who experienced them. They represent the patient’s perspective of their health condition and…
PSH is a patient-centered, team-based system of coordinated care that guides the patient through the entire surgical experience.
PTAN is a Medicare-only number issued to providers by Medicare Administrative Contractors upon enrollment to Medicare – it is also sometimes called…
QE is an entity that has been approved by CMS to access Medicare data for purposes of improving the quality of care.
Qualified Entity Certification Program (QECP) is a program of CMS to certify entities that meet criteria to access Medicare data for public…
A Qualified Health Plan (QHP) is an insurance plan that meets the requirements set forth by the Affordable Care…
Retrospective Audit Contractor (RACs) are private companies that contract with Medicare to review medical records and identify improper payments made under the…
Randomized Controlled Trials (RCTs) are a type of scientific experiment that aims to reduce certain sources of bias when testing the effectiveness…
Rural Health Clinic (RHC) is a clinic located in a rural, medically under-served area in the United States that has a separate…
Research Identifiable File (RIF) is a version of CMS data that contains beneficiary level protected health information.
Receiver Operating Characteristic (ROC) is a statistical measure that evaluates the trade-off between sensitivity and specificity in a binary classification problem.
Socio-Behavioral Determinants of Health (SBDOH) refers to the social, psychological, and behavioral aspects of a person’s life that affect their health and…
Social Determinants of Health (SDOH) are the conditions in the environments in which people are born, live, learn, work, play, worship, and…
Strategic Execution Decision Aid (SEDA) is a tool or set of tools used to support strategic decision-making and execution.
State Innovation Model Initiative (SIM) is a federal program that provides financial and technical support to states for the development and testing…
Skilled Nursing Facility (SNF) is a type of nursing home recognized by the Medicare and Medicaid systems as meeting long term health…
Systematized Nomenclature of Medicine (SNO-MED) is a systematically organized computer processable collection of medical terms providing codes, terms, synonyms and definitions used…
Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it…
Transcatheter Aortic Valve Replacement (TAVR) is a procedure similar to TAVI, which involves the replacement of the aortic valve of the heart…
Total Hip Arthroplasty (THA) is a surgical proceedure to replace the joint in the hip with an artificial joint.
Total Joint Replacement (TJR) is a surgery that replaces an arthritic or dysfunctional joint surface with an orthopedic prosthesis.
Total Knee Arthroplasty (TKA) is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability,…
In the context of healthcare, TPA stands for “Third-Party Administrator.” A TPA is an organization that processes insurance claims or certain aspects…
Value-Based Care (VBC) in healthcare is a delivery model where providers, including hospitals and physicians, are paid based on patient health outcomes.