CCMC Acronyms

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CCMC Acronyms
2013-11-07 22:29:09
CCMC Acronyms

CCMC Acronyms
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  1. SSDI
    Social Security Disability Income
  2. PRO
    Peer Review Organization
  3. CQI
    Continuous Quality Improvement 
  4. IDS
    Integrated Delivery System 
  5. MLR
    • Medical Loss Ratio 
    • The ratio of healthcare costs to revenue received. Calculated as total medical expense divided by total revenue.
  6. MDS
    • Minimum Data Set 
    • The assessment tool used in skilled nursing facility settings to place patients into RUGs
  7. RUGs
    • Resource Utilization Groups 
    • Classifies skilled nursing facility patients into 7 major
    • hierarchies and 44 groups
  8. MAP
    Multidisciplinary Action Plan 
  9. OASIS
    Outcome and Assessment Information Set 

    A prospective nursing assessment instrument completed by home health agencies at the time the patient is entered for home health services
  10. HHRG
    Home Health Resource Group 
  11. CMS
    • Centers for Medicare and Medicaid Services  (formerly known as the Health Care Financing Administration (HCFA))
  12. ASO
    Administrative Services Only 
  13. CPT
    • Current Procedural Terminology
    • A listing of descriptive terms and identifying codes for reporting medical services and procedures performed by health care providers and usually used for billing purposes.
  14. EPO
    • Exclusive Provider Organization 
    • A managed care plan that provides benefits only if care is rendered by providers within a specific network.
  15. FFS
    • Fee-for-Service
    •  Providers are paid for each service performed, as opposed to capitation. Fee schedules are an example of fee-for-service.
  16. HMO
    • Health Maintenance Organization 
    • An organization that provides or arranges for coverage of designated health services needed by plan members for a fixed prepaid premium. There are four basic models of HMOs; group model, individual practice association {IPA), network model, and staff model. Under the Federal HMO Act an organization must possess the following to call itself an HMO;(1) an organized system for providing healthcare in a geographical area, (2) an agreed-on set of basic and supplemental health maintenance and treatment services, and (3) a voluntarily enrolled group of people.
  17. HHRG
    • Home Health Resource Group 
    • Groupings for prospective reimbursement under Medicare for home health agencies. Placement into an HHRG is based on the OASIS score. Reimbursement rates correspond to the level of home health provided.
  18. HINN
    • Hospital-Issued Notice of Noncoverage 
    • A letter provided to patients informing them of insurance noncoverage in case they refuse hospital discharge or insist on continued hospitalization despite the review by the peer review organization (PRO) that indicates their readiness for discharge.
  19. ICD-9-CM
    International Classification of Diseases, Ninth Revision, Clinical Modification, formulated to standardize diagnoses. It is used for coding medical records in preparation for reimbursement, particularly in the inpatient care setting. ICD-10 is expected to be published soon (according to the CCMC book; however it is actually published)
  20. Title XIX" of the Social Security Act of 1966
  21. ADA
    The federal Americans with Disabilities Act of 1990
  22. DME
    • Durable Medical Equipment
    • Equipment needed by patients for self-care. Usually it must withstand repeated use, is used for a medical purpose, and is appropriate for use in the home setting.
  23. URAC
    • Utilization Review Accreditation Commission 
    • A not-for-profit organization that provides reviews and accreditation for utilization review services/programs provided by freestanding agencies. It is also known as the American Accreditation Health Care Commission
  24. CARF
    • Commission on Accreditation of Rehabilitation Facilities 
    • A private, non-profit organization that establishes standards of quality for services to people with disabilities and offers voluntary accreditation for rehabilitation facilities based on a set of nationally recognized standards.
  25. IRF·PAI); 
    Inpatient Rehabilitation Facilities Patient Assessment Instrument The Inpatient Rehabilitation Facilities Patient Assessment Instrument, used to classify patients into distinct groups based on clinical characteristics and expected resource needs. 
  26. RIC
    • Rehabilitation Impairment Categories 
    • Represent the primary cause of the rehabilitation stay. They are clinically homogeneous groupings that are then subdivided into Case Mix Groups (CMGs).