Healthcare Abbreviations & Acronyms

The Affordable Care Act (ACA) is a federal law enacted in the United States to…

An Accountable Care Organization (ACO) is a healthcare delivery model in which a group of…

An Accountable Care System (ACS) is a regional or local healthcare network that integrates various…

Admit/Discharge/Transfer (ADT) refers to the process of tracking and managing patient movements within a healthcare…

Average Length of Stay (ALOS) is a metric that measures the average duration of time…

The American Medical Association (AMA) is a professional organization that represents physicians and medical students…

Acute Myocardial Infarction (AMI), commonly known as a heart attack, occurs when there is a…

Ambulatory Payment Classification (APC) is a system used by the Centers for Medicare and Medicaid…

Advanced Alternative Payment Model (APM) is a payment model that provides financial incentives for healthcare…

An Ambulatory Surgical Center (ASC) is a healthcare facility that specializes in performing outpatient surgical…

A Beneficiary Advisory Committee (BAC) is a committee or group of individuals who represent the…

Bundled Payments for Care Improvement (BPC) is an initiative introduced by the Centers for Medicare…

The Bundled Payments for Care Improvement (BPCI) Initiative is a CMS program that tests alternative…

Coronary Artery Bypass Graft (CABG) is a surgical procedure that restores blood flow to the…

Coronary Artery Disease (CAD) is a condition characterized by the narrowing or blockage of the…

A Critical Access Hospital (CAH) is a small rural hospital that receives special designation and…

A CMS Certification Number (CCN), also known as a Medicare Provider Number, is a unique…

A Coronary Care Unit (CCU) is a specialized hospital unit that provides intensive care and…

The Chronic Condition Warehouse (CCW) is a comprehensive database developed by the Centers for Medicare…

The Chronic Illness and Disability Payment System (CDPS) is a payment model used by some…

Comprehensive ESRD (End-Stage Renal Disease) Care is a program established by the Centers for Medicare…

Congestive Heart Failure (CHF) is a chronic condition in which the heart is unable to…

A Community Health Information Network (CHIN) is a collaboration of healthcare organizations, providers, and stakeholders…

The Children’s Health Insurance Program (CHIP) is a government-funded program in the United States that…

Comprehensive Care for Joint Replacement (CJR) is a bundled payment model introduced by CMS to…

A Case Mix Group (CMG) is a classification system used in healthcare to group patients…

Case Mix Index (CMI) is a measure used to assess the average severity or complexity…

The Center for Medicare & Medicaid Innovation (CMMI) is an agency within CMS responsible for…

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by chronic inflammation, airflow…

Clinical Practice Guidelines (CPGs) are evidence-based recommendations developed by healthcare experts to guide healthcare professionals…

Current Procedural Terminology (CPT) is a standardized coding system developed and maintained by the American…

The Department of Medical Assistance Services (DMAS) is a state agency that administers Medicaid and…

Durable Medical Equipment (DME) refers to reusable medical devices, equipment, or supplies prescribed by a…

The Date of Fill (DOF) refers to the date when a prescription medication is filled…

The Date of Service (DOS) refers to the date when a specific healthcare service or…

Diagnostic Related Grouping (DRG) is a system used in healthcare to classify inpatient hospital cases…

A Disproportionate Share Hospital (DSH) is a healthcare facility that serves a significantly high number…

Evidence-informed Case Rate (ECR) is a payment model used in healthcare that provides a fixed…

An Enrollment Data Base (EDB) is a repository or system that stores and manages data…

Episode Grouper for Medicare (EGM) is a software or tool used by Medicare to group…

An Electronic Health Record (EHR) is a digital version of a patient’s comprehensive medical history,…

Episode Initiators (EI) refer to the events, conditions, or procedures that trigger the start of…

An Electronic Medical Record (EMR) is a digital version of a patient’s medical record, containing…

Episode Payment Models (EPMs) are payment models that provide a single bundled payment for all…

End-Stage Renal Disease (ESRD) refers to the final stage of kidney disease, in which the…

Fee-for-Service (FFS) is a payment model in healthcare where providers are reimbursed based on the…

Fast Healthcare Interoperability Resources (FHIR) is a standard for exchanging healthcare information electronically. FHIR uses…

A Federally Qualified Health Center (FQHC) is a community-based healthcare facility that receives federal funding…

Hospital Acquired Conditions (HACs) refer to medical conditions or complications that patients develop during their…

A Hospital Acquired Infection (HAI), also known as a Hospital Associated Infection, is an infection…

A Hospital-Based Physician (HBP) refers to a physician who primarily practices medicine within a hospital…

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey tool…

Hierarchical Condition Categories (HCCs) is a risk adjustment model used to predict the healthcare costs…

The Healthcare Common Procedure Coding System (HCPCS) is a coding system used to describe and…

The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures…

A Home Health Agency (HHA) is a healthcare organization that provides skilled nursing care, therapy…

The Department of Health & Human Services (HHS) is a federal agency in the United…

Health Information Exchange (HIE) refers to the electronic sharing of patient health information across different…

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law in the United…

The Health Insurance Prospective Payment System (HIPPS) is a payment methodology used in the United…

Hospital Inpatient Quality Reporting (HIQR) is a program implemented by CMS to assess and publicly…

The Health Information Trust Alliance (HITRUST) is an organization that provides a common security framework…

Health Level Seven (HL7) is an international standards organization that develops and promotes standards for…

The Hip Disability and Osteoarthritis Outcome Score (HOOS) is a validated questionnaire used to assess…

A Hospital Outpatient Department (OPD) is a unit within a hospital that provides medical services…

HOS refers to a survey that measures patient health outcomes to ensure quality and effectiveness…

HPI is a detailed record of the symptoms and conditions leading to the current illness…

HRR is a geographical area that characterizes healthcare markets, showing where patients are referred for…

The Hospital Readmissions Reductions Program (HRRP) is a program that aims to reduce hospital readmissions…

The Health Service System (HSS) is a system that provides comprehensive health services, including medical,…

The Hospital Value-Based Purchasing Program (HVBP) is a program that incentivizes hospitals based on their…

The International Classification of Diseases (ICD) is a standardized system of codes used for the…

An Internal Control Number (ICN) is a unique identification number assigned to each Medicare claim…

An Intensive Care Unit (ICU) is a specialized unit within a hospital that provides advanced…

An Integrated Data Repository (IDR) is a centralized database that consolidates and stores various types…

The Institute for Healthcare Improvement (IHI) is a nonprofit organization that promotes and implements evidence-based…

Indirect Medical Education (IME) is a payment adjustment made to teaching hospitals to account for…

An Information Network Project (INP) is a collaborative project that aims to establish an integrated…

An Inpatient Psychiatric Facility (IPF) is a specialized facility that provides diagnostic, therapeutic, and rehabilitative…

An Inpatient Prospective Payment System (IPPS) is a payment system used by Medicare to reimburse…

An Inpatient Quality Reporting (IQR) is a program that requires hospitals to report on various…

An Inpatient Rehabilitation Facility (IRF) is a facility that provides intensive rehabilitative services, including physical…

The Kaiser Family Foundation (KFF) is a nonprofit organization that provides information, analysis, and research…

A Knee Injury and Osteoarthritis Outcome Score (KOOS) is a standardized assessment tool used to…

A Lower-Extremity Joint Replacement (LEJR) is a surgical procedure involving the replacement of a joint…

Low-Income Patients (LIP) are individuals or patients who have limited financial resources and fall within…

Length of Stay (LOS) is the duration of time a patient spends in a healthcare…

A Licensed Practical Nurse (LPN) is a healthcare professional who has completed a practical nursing…

Lifetime Reserve Days (LDRs) are additional days that Medicare will pay for when you’re in…

A Long-Term Care Hospital (LTCH) is a hospital that specializes in treating patients who may…

Low Utilization Payment Adjustment (LUPA) refers to a payment adjustment under the Medicare home health…

Medicare Advantage (MA) is a type of health insurance that provides Medicare benefits through a…

A Medicare Administrative Contractor (MAC) is a private healthcare insurer that has been awarded a…

Medicare and CHIP Reconciliation Act (MACRA) is a federal legislation that established new ways to…

Medicaid Analytic Extract (MAX) is a set of files containing Medicaid enrollee information, including demographic…

Master Beneficiary Summary File (MBSF) is a database that includes a comprehensive set of beneficiary-level,…

Major Complications or Comorbidities (MCC) refer to secondary diagnoses that significantly complicate a patient’s primary…

A Managed Care Organization (MCO) is a type of health insurance where a company contracts…

A Medicaid Managed Care Plan (MCP) is a health care plan in which Medicaid recipients…

Major Diagnostic Categories (MDCs) are groups of diagnoses that have similar clinical characteristics and similar…

Medicare Drug Integrity Contractors (MEDICs) are entities contracted by CMS to detect and prevent fraud,…

Merit-Based Incentive Payment System (MIPS) is a payment mechanism that provides adjustments to eligible clinicians…

Maximum Out of Pocket (MOOP) is the most you have to pay for covered services…

Medicare Severity Diagnosis Related Groups (MS-DRGs) are a classification system that groups patients with similar…

Management Services Organizations (MSOs) in healthcare are entities that provide non-clinical administrative services to healthcare…

Medicare Spending Per Beneficiary (MSPB) measures the cost to Medicare for services performed by an…

Non-claims Based Payments (NCBPs) are payments made to providers that aren’t based on individual claims…

National Drug Code (NDC) is a unique product identifier used in the United States for…

The National Institutes of Health (NIH) is a part of the U.S. Department of Health…

National Provider Identifier (NPI) is a unique identification number for covered healthcare providers used in…

Nonphysician Practitioner (NPP) refers to healthcare providers who are not physicians but who perform some…

Net Payment Reconciliation Amount (NPRA) is the difference between a health plan’s target amount and…

Outcome and Assessment Information Set (OASIS) is a standardized assessment used in the home healthcare…

Oncology Care Mode (OCM) is a payment and delivery model that aims to provide higher…

The Office of Management and Budget (OMB) is a federal agency that evaluates, formulates, and…

The Office of the National Coordinator for Health Information Technology (ONC) is a division of…

Out of Pocket (OOP) refers to medical costs that are not covered by insurance and…

Outpatient Prospective Payment System (OPPS) is a system by which Medicare decides how much money…

Principal Accountable Provider (PAP) refers to the healthcare provider who is primarily responsible for coordinating…

Pharmacy Benefit Managers (PBMs) are companies that manage prescription drug benefits on behalf of health…

Percutaneous Coronary Intervention (PC) is a non-surgical procedure used to treat the stenotic (narrowed) coronary…

PECOS is the online Medicare provider and supplier enrollment system. It allows providers and suppliers…

Physician Group Practice (PGP) refers to a healthcare provider organization in which physicians are organized…

Protected Health Information (PHI) is any information in a medical record that can be used…

Personal Health Records (PHR) is an electronic record of health-related information on an individual that…

Personally Identifiable Information (PII) is any information that can be used to identify the identity…

Per Member Per Month (PMPM) is a method of calculating healthcare costs based on the…

Per Member Per Year (PMPY) is a method of calculating healthcare costs based on the…

Present on Admission (POA) is a billing term that refers to conditions present when the…

POC is a realization of a certain method or idea to demonstrate its feasibility, or…

PPS is a method of reimbursement in which Medicare payment is made based on a…

PROMIS is a system of measures of patient–reported health status for physical, mental, and social…

PROMs are a type of patient-reported outcome measure that can be used in clinical practice…

PROs are health outcomes directly reported by the patient who experienced them. They represent the…

PSH is a patient-centered, team-based system of coordinated care that guides the patient through the…

PTAN is a Medicare-only number issued to providers by Medicare Administrative Contractors upon enrollment to…

QE is an entity that has been approved by CMS to access Medicare data for…

Qualified Entity Certification Program (QECP) is a program of CMS to certify entities that meet…

Retrospective Audit Contractor (RACs) are private companies that contract with Medicare to review medical records…

Randomized Controlled Trials (RCTs) are a type of scientific experiment that aims to reduce certain…

Rural Health Clinic (RHC) is a clinic located in a rural, medically under-served area in…

Research Identifiable File (RIF) is a version of CMS data that contains beneficiary level protected…

Receiver Operating Characteristic (ROC) is a statistical measure that evaluates the trade-off between sensitivity and…

Socio-Behavioral Determinants of Health (SBDOH) refers to the social, psychological, and behavioral aspects of a…

Social Determinants of Health (SDOH) are the conditions in the environments in which people are…

Strategic Execution Decision Aid (SEDA) is a tool or set of tools used to support…

State Innovation Model Initiative (SIM) is a federal program that provides financial and technical support…

Skilled Nursing Facility (SNF) is a type of nursing home recognized by the Medicare and…

Systematized Nomenclature of Medicine (SNO-MED) is a systematically organized computer processable collection of medical terms…

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive surgical procedure repairs the valve without…

Transcatheter Aortic Valve Replacement (TAVR) is a procedure similar to TAVI, which involves the replacement…

Total Hip Arthroplasty (THA) is a surgical proceedure to replace the joint in the hip…

Total Joint Replacement (TJR) is a surgery that replaces an arthritic or dysfunctional joint surface…

Total Knee Arthroplasty (TKA) is a surgical procedure to replace the weight-bearing surfaces of the…

Value-Based Care (VBC) in healthcare is a delivery model where providers, including hospitals and physicians,…