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Economics: Glossary of Acronyms and Terms
Courtesy of Kay Moyer, MS, ACR Economic Analyst
APC
Ambulatory Payment Classification – A classification system of the
Medicare Hospital Prospective Payment System. Each APC is a package of
medical services that are clinically similar with respect to resources,
which CMS has determined should be grouped together and paid at one
rate.
CAC
Carrier Advisory Committee – Established to provide a forum for
physicians in a state or region to stay informed and participate in the
development of local Medicare policy.
CMS
Centers for Medicare and Medicaid Services – Is a federal agency
within the Department of Health and Human Services. CMS administers many
health programs for the people of the United States. Some of these
programs include Medicare, Medicaid, Health Insurance Portability and
Accountability Act (HIPAA) and others
CPT®
Current Procedural Terminology – A listing of descriptive terms
and identifying codes for reporting medical services and procedures. The
CPT® codes are maintained and copyrighted by the American Medical
Association.
HCPCS
Healthcare Common Procedural Coding System – A code set used for
reporting healthcare procedures, the use of medical equipment and
supplies for the claim submission process.
HOPPS
Hospital Outpatient Prospective Payment System – A CMS mandated
payment system for hospital outpatient procedures. Services paid by
HOPPS are grouped into APCs.
IDTF
Independent Diagnostic Testing Facility
LCD
Local Coverage Determination – This is Medicare payment policy
determined at the local/state level. The LCD is a decision made by a
fiscal intermediary or carrier whether to cover a particular service or
procedure.
MPFS
Medicare Physician Fee Schedule – The Medicare payment system
used to reimburse physicians for their services performed on Medicare
beneficiaries. The MPFS is based on a resource value system whereby each
procedure code is assigned a value based on the resources needed to
provide that service and then paid accordingly.
MQSA
Mammography Quality Standards Act – For more information, see
this site: http://www.fda.gov/cdrh/mammography/frmamcom2.html
RVS
Relative Value Scale – A ranking of a group of physician services
with respect to each other within the Medicare Physician Fee Schedule.
The rankings are based on the resources required to provide the
services.
RUC
Relative Value Scale Update Committee
ICD-9-CM
International Classification of Diseases, 9th Revision,
Clinical Modification – A comprehensive list of numerical codes assigned
to diagnoses that is used as the basis of reporting and billing. The
codes are most commonly used to indicate why a patient had a particular
procedure or imaging study or what the outcome of the study was.
AMA
American Medical Association
HIPAA
Health Insurance Portability and Accountability Act
TC
Technical Component – The technical component of a service includes
expenses incurred from the actual administration of a service such as
non-physician clinical labor, medical supplies and medical equipment
used to provide a service. The technical component is one of three
divisions of the Medicare Physician Fee Schedule. The others are the
professional component (PC) and the global component.
PC
Professional Component – Medicare defines the professional
component of a service that requires the professional expertise of a
physician. Generally, the professional component includes physician
work, associated overhead and professional liability insurance. For
inpatient, outpatient and other facilities, physicians may be restricted
to only billing the professional component of a service. This is
identified by appending a 26 modifier to the CPT® procedure code.
Continue reading to learn about the details of the process.
Learn more:
- Creating a CPT® Code
- Assigning a Value to the Code
- Reimbursement
Other links:
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