Glossary Word        Definition BRAT        Acronym for a diet of Bananas, Rice, Apples and Toast that has historically been recommended for patients with various forms of gastrointestinal distress such as diarrhea, dyspepsia, and/or gastroenteritis. Extensions to the BRAT diet include BRATT (Bananas, Rice, Applesauce, Toast, and Tea) and BRATY (Bananas, Rice, Applesauce, Toast, and Yogurt).  The BRAT diet consists of foods that are relatively bland, easy to digest, and low in fiber. Low-fiber foods are recommended because foods high in fiber may cause gas, possibly worsening the gastrointestinal upset.   (Note. Raw pectin in apples acts as a binder to help solidify the stool) Doximity        Doximity (doximity.com) is an online professional network for U.S. physicians. 6MWT        Six Minute Walk Test - The original purpose of the six minute walk was to test exercise tolerance in chronic respiratory disease and heart failure. The test has since been used as a performance-based measure of functional exercise capacity in other populations including healthy older adults, people undergoing knee or hip arthroplasty, fibromyalgia, and scleroderma. It has also been used with children.  Ref1 A1c        A blood test used to diagnose type 1 and type 2 diabetes and to later gauge how well you're managing your diabetes. The A1C test also goes by many other names, including glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C and HbA1c.  Unlike finger sticks you can do at home, which measure your blood sugar level at a given time, the A1C test reflects your average blood sugar level for the past two to three months.  Specifically, the A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control. And if you have previously diagnosed diabetes, the higher the A1C level, the higher your risk of diabetes complications. AAA        Abdominal Aortic Aneurysm -  for recommendations on screening see U.S. Preventive Services Task Force (USPSTF). AAFP   American Academy of Family Physicians, see Professional Organizations. See FAAFP AANP        American Association of Nurse Practitioners (AANP) – Formed from merger of The American Academy of Nurse Practitioners and the American College of Nurse Practitioners in November 2012 with 41,000 members. AAPC        American Academy of Professional Coders AAPS        Association of American Physicians and Surgeons ABCC        American Board of Comprehensive Care ABFM        American Board of Family Medicine.  A physician can be board certified by ABFP without being an AAFP member. ABI        Ankle-Brachial Index test - This test is done by measuring blood pressure at the ankle and in the arm while a person is at rest. Measurements are usually repeated at both sites after 5 minutes of walking on a treadmill.  The ankle-brachial index (ABI) result is used to predict the severity of peripheral arterial disease (PAD). A slight drop in your ABI with exercise means that you probably have PAD. This drop may be important because PAD can be linked to a higher risk of heart attack or stroke. ABIHM        American Board of Integrative Holistic Medicine (Note: The ABMS (American Board of Medical Specialties) does not recognize this certification) ABN        Advance Beneficiary Notice - physicians may use the revised ABN for all situations where Medicare payment is expected to be denied.  See March 2008 revision abx        Antibiotics ACA        Affordable Care Act ACE inhibitor        Angiotensin-Converting-Enzyme inhibitor - ACE inhibitors are used primarily and to treat hypertension, although they may also be prescribed for cardiac failure, diabetic nephropathy, renal disease, systemic sclerosis, left ventricular hypertrophy and other disorders ACEI        See ACE ACNP        American College of Nurse Practitioners ACO        Accountable Care Organizations –  An idea introduced in the proposed healthcare reform act.  The Medicare program would allow groups of providers who voluntarily meet certain statutory criteria, including quality measurements, to be recognized as ACOs and be eligible to share in the cost-savings they achieve for the Medicare program.  ACOs would have the opportunity to qualify for an incentive bonus.  Eligible ACOs would be defined as groups of providers and suppliers who have an established mechanism for joint decision making, such as for capital purchases. ACO's could work well for closed systems (think Mayo, Geisinger) and have demonstrated good results.   The question is how/whether they will work for small/solo group practices.  There is some debate about whether "virtual" ACO's can be formed to meet the need for a large enough patient base (at least 5,000 Medicare patients, lots more for healthier/commercial insurance.) ACO        Accountable Care Organization - an integrated health care delivery system that relies on a network of primary care physicians, one or more hospitals, and subspecialists to provide care to a defined patient population. Under the model, hospital and physician networks would be responsible for the quality of care delivered to patients and would receive bonuses for providing high-quality, low-cost care. It's also possible that penalties would be levied for delivering low-quality, high-cost care. ACO’s are not the same as IPA’s.  The ACO is effectively an insurer, actually, albeit one owned by doctors.  You are signing a risk contract with Medicare / Medicaid the same as any of the advantage plans.  Our IPA works but it is Primary Care controlled and managed. Details are buried in the Health Reform law.  Group of doctors can contract directly with Medicare, with no reserve, as a standard insurance would need.  Basically our reserve is the federal government.  The way it is constructed, details are still to be worked out.   For this to work it needs to be led by Primary Care. Accountable Care Organizations (ACOs) are the latest rage in the health policy world.  The question is, what are ACOs.   The Urban Institute’s Kelly Devers and Robert Berenson try to answer the following question: “Can Accountable Care Organizations Improve the Value of Health Care by Solving the Cost and Quality Quandaries?”  (read more) Reference: Dartmouth Institute for Health Policy and Clinical Practice appears to be a major proponent of ACOs (http: //www.dartmouthatlas.org) ACP        American College of Physicians – Internal Medicine subspecialty (130,000+ members), see Professional Organizations ACS        American College of Surgeons – 70,000+  members, see Professional Organizations ACTB        Authorized Certification and Testing Body Actinic Keratosis        Actinic Keratosis (AK) is a benign, but pre-cancerous skin lesion due to long term sun damage. AKs that appear today are generally the result of sun exposure twenty or more years earlier. AKs vary in size, from a few millimeters in diameter, to over 3 centimeters across. Lesions also vary in color, (light or dark tan, red, or pink). AKs are generally scaly or rough to the touch, and an individual may present with several lesions simultaneously. Diagnosis and Treatment – AK lesions are suspected based on their typical appearance and location, such as the face, forehead, ears, bald scalp and forearms. The diagnosis is usually confirmed by a biopsy, obtained by excising a thin layer of the lesion under local anesthesia. Once the diagnosis is confirmed, the lesion is either fully removed with a scalpel (excision), or with cryosurgery (local freezing of the lesion by application of liquid nitrogen). Alternatively, topical creams, applied to the lesion over several months, can be used to treat AKs. Creams such as Aldera, Solarez, and Efudex have all been shown to be effective treatment for AK lesions. Admission types        In general the terms in-patient and out-patient are relative to treatment in a hospital. In-Patient – The length of stay usually is more than one day Observation level –  When the physician needs more time to monitor/observe (usually < 24 hrs) Out-Patient level – planned short stays (day surgery, transfusions, CT scans, etc) Advance Health Care Directive        An Advance Health Care Directive, also known as living will, personal directive, advance directive, or advance decision, is a set of written instructions that a person gives that specify what actions should be taken for their health if they are no longer able to make decisions due to illness or incapacity. The instruction appoints someone, usually called an agent, to make such decisions on their behalf. A living will is one form of advance directive, leaving instructions for treatment. Another form authorizes a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions on their behalf when they are incapacitated. People may also have a combination of both. People are often encouraged to complete both documents to provide comprehensive guidance regarding their care.  One example of a combination document is the Five Wishes advance directive in the United States.  (Also see POLST) Advanced Access Scheduling        Mark Murray, MD, the self-proclaimed 'grandfather' of the application of the 'open access' or 'advanced access' theory in healthcare scheduling, began working on the process, along with colleague Catherine Tantau, in the late 1980s. In true advanced access, according to Murray, physicians schedule "today's work today," working with a daily schedule that is 75 percent open for the average family practice. Ref1, Ref 2 AFMCP        Applying Functional Medicine in Clinical Practice, a conference sponsored by  The Institute of Functional Medicine AHA         American Hospital Association AHDI          Association for Healthcare Documentation Integrity AHIMA        The American Health Information Management Association (AHIMA) AHRQ        Agency for Healthcare Research and Quality AK        Actinic Keratoses AlaHA        Alabama Hospital Association All        Allergies AMA        American Medical Association, see Professional Organizations Ambu        Proprietary name  for Bag Valve Mask (BVM) Ambulatory Surgery        Surgery done in the doctor’s office or at a surgical center, and not requiring an overnight stay. AMD        Age-related macular degeneration AMDIS        A sister association of the Healthcare Information Management and Systems Society (HIMSS), whose members include Siemens, GE, Allscripts, McKesson, Epic, Nextgen, and other large EHR vendors. HIMSS helped found and fund CCHIT, the Certification Commission for Health Information Technology AMIA        American Medical Informatics Association (AMIA)  (Ref1) AMRI        American Medical Resource Institute,  The nation's largest free-standing provider of ACLS and PALS education analgesic        An analgesic is any member of the group of drugs used to achieve analgesia, relief from pain. Ancillary Providers        Services over and above physician services, including laboratory, radiology, home health and skilled nursing facilities. ANI        Alliance for Nursing Informatics Antitrust law        United States antitrust law is a collection of federal and state government laws, which generally aims to regulate the conduct of business corporations to promote competition, usually for the benefit of consumers. The primary statutes are the Sherman Act 1890, the Clayton Act 1914 and the Federal Trade Commission Act 1914. They are believed to be necessary for keeping companies from becoming too large and fixing prices, and also encourage competition so that consumers can receive quality products at reasonable prices. According to its proponents, these laws give businesses an equal opportunity to compete for market share. Preventing monopolies ensures that consumer demand is met in a fair and balanced way. There are four sections that the laws focus on including agreements between competitors, contracts between buyers and sellers, mergers and monopolies.  In general antitrust law 1 Prohibits agreements or practices that restrict free trading and competition between business. This includes in particular the repression of free trade caused by cartels. 2. Bans abusive behavior by a firm dominating a market, or anti-competitive practices that tend to lead to such a dominant position. Practices controlled in this way may include predatory pricing, tying, price gouging, refusal to deal, and many others. 3. Supervises the mergers and acquisitions of large corporations, including some joint ventures.  Transactions that are considered to threaten the competitive process can be prohibited altogether, or approved subject to "remedies" such as an obligation to divest part of the merged business or to offer licenses or access to facilities to enable other businesses to continue competing. Note:  A company buying an interest in small groups can bargaining with insurance companies without getting into antitrust issues since they are owners. APACHE        Acute Physiology and Chronic Health Evaluation -  is a severity of disease classification system, one of several ICU scoring systems. After admission of a patient to an intensive care unit, an integer score from 0 to 71 is computed based on several measurements; higher scores imply a more severe disease and a higher risk of death. (Note: There are overlapping nationwide quality/safety initiatives. For example Leapfrog, or a Million Lives Campaign.   Several of them recommend closed ICUs and other practice patterns that stifle continuity and purport to be safer.) APN        Advanced Practice Nurse - APN defines a level of nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, planning, implementation, diagnosis and evaluation of the care required. Appy        Appendix APRN        Advance Practice Registered Nurse ARNP        Advanced Registered Nurse Practitioner ARRA        American Recovery and Reinvestment Act of 2009, see HITECH ASHD        Arteriosclerotic heart disease Assigned Claim        See “Unassigned Claim” ATCB        Authorized Testing and Certification Bodies.  The Office of the National Coordinator for Health Information Technology (ONC) announced that it had designated two organizations, Drummond Group, Inc., and the Certification Commission for Health Information Technology (CCHIT) to serve as Authorized Testing and Certification Bodies (ONC- ATCBs). Authorization         Approval of care required before a service is provided. Pre-authorization may be necessary before hospital admission, or before care is given by non-HMO providers. AWV        Medicare’s Annual Wellness Visit .  Also see relationship to IPPE b.i.d. (bid or BID)        is twice a day; b.i.d.. stands for "bis in die" (which means, in Latin, twice a day). balance billing        An approach to billing that implies billing the difference between your full charges and what the insurance carrier paid.  In general this only applies if you not participating in a plan that sets fees. Billing a patient for charges not paid by their insurance plan because the charges are above the Usual and Customary Rate or because the insurer considered a procedure medically unnecessary. Beers Criteria        Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, informally known as Beers List, is a reference about the safety of prescribing medications for older adults.  Mark H. Beers, MD, a geriatrician, first created the Beers Criteria in 1991, through a consensus panel of experts by using the Delphi method.   Ref1 BHIE        Bidirectional Health Information Exchange Blue Button        The Blue Button is a symbol for patients to view online and download their own personal health records. Blue Button is in widespread use by hospitals, doctors and health plans across the United States.[Several Federal agencies, including the Departments of Defense, Health and Human Services, and Veterans Affairs, implemented this capability for their beneficiaries. Although format and content of data downloaded via Blue Button may differ from system to system, it is intended to be both readable by humans and parse-able by software. Data from Blue Button-enabled sites can be used to create portable medical histories that facilitate dialog among health care providers, caregivers, and other trusted individuals or entities. The Veteran Administration Blue Button allows veterans to access and download information from their My HealtheVet personal health record Blue Cross        https://www.bcbsal.org/providers/publications/providerFacts/2009-01.pdf BlueCross BlueShield Provider Facts        A bimonthly publication of BlueCross BlueShield of Alabama,  2009 January- February BMD        Bone Mineral Density BOD        Board of Directors BP        Blood Pressure, No significant difference in blood pressure recorded over a sleeve or on a bare arm in study of   376 patients published in 2008: Bundling        Bundling is when an insurance carrier combines two or more CPT codes, substituting one overarching code, often ignoring modifiers along the way. Bundling can cut down on your receivables because by bundling the codes together they are only allowing the fee schedule allowance for the one code that they feel is appropriate.  There are ways to get around bundling... BVM        A bag valve mask, abbreviated to BVM and sometimes known by the proprietary name Ambu bag, is a hand- held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately. The device is a normal part of a resuscitation kit for trained professionals, such as ambulance crew. The BVM is frequently used in hospitals, and is an essential part of a crash cart. The device is used extensively in the operating room to ventilate an anaesthetised patient in the minutes before a mechanical ventilator is attached. The device is self-filling with air, although additional oxygen (O2) can be added. BX        Biopsy CABG        Coronary Artery Bypass Grafting CACC        Council for the Advancement of Comprehensive Care is the leading academic organization for the promulgation of doctoral level clinical nursing. The Council is a consortium of distinguished academic and health policy leaders who are committed to assuring high standards of doctoral nursing practice. CAD        Coronary Artery Disease CAH         Critical Access Hospital CAHPS        Consumer Assessment of Healthcare Providers and Systems surveys ask consumers and patients to report on and evaluate their experiences with health care.  See AHRQ CAM        Complementary and Alternative Medicine (CAM) is the term for medical products and practices that are not part of standard care. Standard care is what medical doctors, doctors of osteopathy and allied health professionals, such as registered nurses and physical therapists, practice. Alternative medicine means treatments that you use instead of standard ones. Complementary medicine means nonstandard treatments that you use along with standard ones. Examples of CAM therapies are acupuncture, chiropractic and herbal medicines. Capitation        A uniform per capita payment or fee.  The payment of a fee to a doctor determined by the number of patients. CAQ        Certificates of Added Qualifications (CAQs) - The American Board of Family Medicine (ABFM) offers Certificates of Added Qualifications (CAQs) in Adolescent Medicine, Geriatric Medicine, Hospice and Palliative Medicine, Sleep Medicine, and Sports Medicine. CAQH        Council for Affordable Quality Healthcare - An alliance of health plans and trade associations collaborating on initiatives that simplify healthcare administration. Providers can do credentialing documentation activities through CAQH.  In general, you still have to contact each insurance company that you wish to contract with. They have to manually start the process and send you a contract. Some will require additional forms.  Some insurance plans require you to do CAQH, others will require you to fill out their “proprietary” forms. Care Credit        Care Credit -A finance option that allows patients to pay over time.  Various terms are offered. Carve-out Policy        A contracted agreement between an insurance company and another company which provides special services to its members, such as prescription drugs or cancer treatment. CAT scan        See Computed Tomography (CT) Category III codes        Temporary CPT codes for emerging technology, services, and procedures CBC        Complete Blood Count: counting the number of white and red blood cells and the number of platelets in 1 cubic millimeter of blood CBO        Community-Based Organization CBT        Cognitive Behavior Therapy CC        Chief Complaint CCD        Continuity of Care Document the CCD combines the benefits of (CCR) and the (CDA) specifications.  In essence, CCR + CDA became CCD. CCD+        The CCD+ format is a National Automated Clearing House Association (NACHA) ACH corporate payment format with a single 80 character addendum record capability. The addendum record is used by the originator to provide additional information to the payment recipient about to the payment.  See EFT CCHIT         Certification Commission for Health Information Technology CCI        Correct Coding Initiative (CCI). Also see NCCI, Ref1, Ref2, Ref3.  Also see AMA publication “Understanding Medicare's NCCI Logic and Interpretation of the Edits” by Susan Garrison CCR        Continuity of Care Record standard, a content messaging standard that uses XML to create a summary of a person's relevant medical data, in computable and human readable format. Basically, the building block for EHR interoperability. One of two standards using XML for this purpose included in the IFR discussed here. CDA        Clinical Document Architecture CDHP        Consumer-Driven Health Plans - An alternative to a regular health plan is a consumer driven health plan. These health plans are often used together with a high deductible health plan that helps when a catastrophic medical event occurs. A high deductible health plan is a plan that, as the name suggests, has a high deductible to meet. This plan also has a set out-of-pocket maximum and low premium costs. Deductible minimums and out-of-pocket maximums are set every year by the IRS.  Also see:   Flexible Spending Account (FSA   Health Reimbursement Account (HRA   Health Savings Account (HSA)   Medical Savings Account (MSA) CDHP        Consumer-Driven Health Plan CDL        A Commercial Driver's License (CDL) is a driver's license required in the United States to operate any type of vehicle which has a gross vehicle weight rating (GVWR) of 26,001 lb or more for commercial use, or transports quantities of hazardous materials that require warning placards under Department of Transportation regulations, or that is designed to transport 16 or more passengers, including the driver. For Medical examiners: Register, Find who is certified, Find a training organization Note: As of May 2014, medical examiners of commercial drivers must complete Federal Motor Carrier Safety Administration (FMCSA) training every 5 years and pass a certification examination every 10 years. CDO        Care Delivery Organization CDR        Clinical Data Repository– An AAFP project to improve practice revenue and enhance the quality of care delivered to patients. CDS        Clinical Decision Support CDT        Catheter-Directed Thrombolysis, also see DVT and PST, Ref 1 CER        Comparative Effectiveness Research (See IOM recommendations) CFPC        Certified Family Practice Coder (training aids) CFR        Code of Federal Regulations CGD         Certification Guidance Document CHADIS        Child Health and Development Interactive System. CHADIS: 1. delivers the doctor's pre-selected questionnaires and families complete them online at home or in the waiting room 2. collects all the answers, and automatically scores and tabulates them in an user-friendly electronic worksheet 3. presents provisional diagnoses and links to decision-support information based on the responses 4. selects informational handouts and community resources specific to the child and family needs5. 5. captures additional Clinician comments and information during the office visit 6. stores all visit data, creating a full record that can be copied into EMRs for referrals, billing, positive screen registry and patient diagnoses tracking Similar in concept to Instant Medical History (IMH) CHC        Connected Healthcare Community CHC        Community Health Centers Chief Complaint        A chief complaint is the establishment of a problem-focused visit vs. a preventive or procedural service. It has little other impact on the type or level of service reported. If the average coder or clinician reading the record can determine the chief complaint from the combination of history and assessment, The intent of documenting a chief complaint has been met. Ii general there is nothing in the documentation guidelines that require the chief complaint be a separate statement in the record. The guidelines indicate that the CC, ROS, and PSFH may be listed as separate elements of history or they may be included in the HPI.  Note that "physician recommended return" is included in the description of chief complaint in the guidelines. For example, "I am here for a follow-up" can so quickly become "I have been having this heaviness in my chest for a week". CHIME         College of Healthcare Information Management Executives CHIPRA        Children’s Health Insurance Program Reauthorization Act CHIT        Center for Health Information Technology - The Center for Health Information Technology is the focal point of the AAFP's technical expertise, advocacy, research, and member services associated with medical office automation and computerization. Concise Guide to CCHIT Standard chol        cholesterol CHPL        The Certified HIT Product List (CHPL) provides the authoritative, comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program maintained by the Office of the National Coordinator for Health IT (ONC). Each Complete EHR and EHR Module listed below has been certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB) and reported to ONC. Only the product versions that are included on the CHPL are certified under the ONC Temporary Certification Program. Please note that the CHPL is a “snapshot” of the current list of certified products. The CHPL is updated frequently as newly certified products are reported to ONC. CHR        Community Health Records Civil Surgeon        Civil Surgeons are designated by the District Director of the US Citizenship and Immigration Services.  Ref1, Ref2, Ref3 CK        Creatine kinase (CK), also known as creatine phosphokinase.  Clinically, creatine kinase is assayed in blood tests as a marker of myocardial infarction  rhabdomyolysis, muscular dystrophy, the autoimmune myositides and in acute renal failure. CKD        Chronic Kidney Disease (CKD) Claim        A record of medical services provided to a patient and submitted by the provider to the insurance company for payment. Claims Review        The method by which a patient’s health care service claims are reviewed before reimbursement is made. This is done to validate the appropriateness of services given and that the cost is not excessive. CLIA        Clinical Laboratory Improvement Amendments, Clinical Laboratory Improvement Amendments of 1988 - The idea behind CLIA is fairly straightforward: to ensure the accuracy and timeliness of patient test results, regardless of whether the test is performed in a multimillion dollar off-site lab or in a physician's office. CLIA implementation is the responsibility of the Centers for Medicare & Medicaid Services, which oversees registration, certificates, fees, and compliance surveys. CMMI        Center for Medicare and Medicaid Innovations See Comprehensive Primary Care Initiative (CPPI) and PCMH. The primary care deliverables for the CPCI are: 1. Access and continuity 2. Planned care for chronic conditions and preventative care 3. Risk-stratified care management 4. Patient and caregiver engagement 5. Coordination of care CMP        Comprehensive Metabolic Panel - a blood test that provides information about: how the kidney and liver are functioning, sugar (glucose) and protein levels in the blood, the body's electrolyte and fluid balance CMS        Centers for Medicare and Medicaid Services (CMS). US federal agency which administers Medicare, Medicaid, and the Children's Health Insurance Program. Official Website, Formerly known as HCFA CMS 1500        Form CMS-1500 is the standard paper claim form used by health care professionals and suppliers to bill Medicare Carriers.  See detailed information on completing the Form CMS-1500. This manual may be found at http: //www.cms.gov/manuals/downloads/clm104c26.pdf on CNM        Certified Nurse Midwife CNMW        Certified Nurse MidWife COB        Coordination of Benefits is the practice of ensuring that insurance claims are not paid multiple times, when an enrollee is covered by two health plans at the same time. COD        Congress of Delegates - the AAFP Congress of Delegates Cognitive dissonance        Cognitive dissonance is A discomfort caused by holding conflicting cognitions (e.g., ideas, beliefs, values, emotional reactions) simultaneously. In a state of dissonance, people may feel surprise, dread, guilt, anger, or embarrassment. The theory of cognitive dissonance in social psychology proposes that people have a motivational drive to reduce dissonance by altering existing cognitions, adding new ones to create a consistent belief system, or alternatively by reducing the importance of any one of the dissonant elements. An example of this would be the conflict between wanting to smoke and knowing that smoking is unhealthy; a person may try to change their feelings about the odds that they will actually suffer the consequences, or they might add the consonant element that the smoking is worth short term benefits. A general view of cognitive dissonance is when one is biased towards a certain decision even though other factors favor an alternative. coins        Coinsurance Coinsurance         A provision which limits the amount of the coverage paid by an insurance plan to a certain percentage, with the remaining costs paid by the member. Concierge medicine        Concierge medicine (also known as retainer-fee medicine) uses the approach of boosting physician income through a retainer fee that allows physicians to reduce patient volume. Some medical practices have combined both the IMP and the retainer fee approach. CONNECT        CONNECT - an open source software solution that supports health information exchange – both locally and at the national level. CONNECT uses Nationwide Health Information Network (NHIN) standards and governance to make sure that health information exchanges are compatible with other exchanges being set up throughout the country.  This software solution was initially developed by federal agencies to support their health-related missions, but it is now available to all organizations and can be used to help set up health information exchanges and share data using nationally-recognized interoperability standards. Co-payment        The portion of a claim that a member must pay out-of-pocket. COPD        Chronic Obstructive Pulmonary Disease - A progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.   COPD can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness, and other symptoms.  Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust, also may contribute to COPD.  Diagnostic test include   Spirometry Testing   Alpha-1 Antitrypsin Deficiency Screening   Arterial Blood Gases.   Lung Volume Studies   Chest X-rays counseling        CPT defines counseling as a component of E/M services as the following: Counseling is a discussion with a patient and/or family concerning one or more of the following areas: 1. Diagnostic results, impressions, and/or recommended diagnostic studies Prognosis 2. Risks and benefits of management (treatment) options 3. Instructions for management (treatment) and/or follow-up 4. Importance of compliance with chosen management (treatment) options 5. Risk factor reduction 6. Patient and family education Documentation of the approximate total time and time or % of time spent counseling must be documented. Also the types of discussions listed in the definition of counseling should be documented when billing an E/M based on time (more than 50% spent counseling and/or coordinating care). Medicare does require that the time of the E/M service be met or exceeded. CPT states that when codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used. As previously noted, payers may choose to follow the Medicare guideline. CPAP        Continuous Positive Airway Pressure, a variation of the Positive airway pressure (PAP)  method of respiratory ventilation used primarily in the treatment of sleep apnea, for which it was first developed. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, and in newborn infants (neonates). In these patients, it can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation. CPC        Certified Professional Coder CPCI        Comprehensive Primary Care Initiative (CPCI) from the CMS Innovation Center is a program that organizes a "supportive multi-payer environment" in a market such that 60% or more of the payers in a market are participating in the new payment model. The program emphasizes many of the same practice characteristics that we have promoted in the PCMH model. The payment model is a blended payment that includes fee-for-service, a care management fee and a shared savings opportunity. A four year demonstration program will determine if the model proves successful, CPE        Complete Physical Exam CPE        Certified Public Expenditures - In this cost-based reimbursement approach, healthcare providers that are owned by the state, counties, cities or another public entity may certify their costs related to providing Medicaid covered services to Medicaid clients, and then in turn draw down the applicable federal Medicaid matching funds associated with those costs. These initiatives are available for all types of publicly-owned providers, including hospitals, nursing homes and clinics. This can be done in addition to an existing reimbursement rate structure if the current Medicaid rates paid to these public providers do not cover the costs of providing these services. CPE        Continuing Professional Education CPOE        Computerized Physician Order Entry (CPOE).  These orders are communicated over a computer network to the medical staff (nurses, therapists, pharmacists, or other physicians) or to the departments (pharmacy, laboratory or radiology) responsible for fulfilling the order. CPOE is also referred to ePrescribing for ordering of medications. CPT        Current Procedural Terminology  - The CPT code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set accurately describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. The current version is the CPT 2010. There are three types of CPT codes:   Category I CPT Code(s)   Category II CPT Code(s) – Performance Measurement   Category III CPT Code(s) – Emerging Technology Note, AMA owns  CPT.  Each year, AMA issues a roster of CPT changes that become effective Jan. 1. (Article), CPT-4        A 5-digit code that applies to medical services delivered. CQM        Clinical Quality Measures. The Meaningful Use criteria for in-hospital EHR technology includes a set of Clinical Quality Measures. credentialing        See CAQH and UPD CRF        Chronic Renal Failure (CRF) CRFM        Coalition for the Rescue of Family Medicine CRNA        Certified Registered Nurse Anesthetist CRON        Calorie Restriction, Optimal Nutrition – a diet for those who are seeking life extension, Roy Wolford was one of the leaders/researchers of this movement.. CT        X-ray Computed tomography, a medical imaging method often referred to as a CT or CAT scan, CVA        Cerebrovascular accident: The sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A CVA is also referred to as a stroke. Symptoms of a stroke depend on the area of the brain affected. The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of voluntary movement or sensation in a leg or arm. There can be speech problems and weak face muscles, causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain can affect balance, vision, swallowing, breathing and even unconsciousness. DAW        Dispense As Written (prevents generic substitutions). Alternatives include “Brand Medically Necessary” DAW        Dispense As Written - "brand necessary", "do not substitute", "no substitution", "medically necessary", "do not interchange".[ DD, DDx        differential diagnosis (sometimes abbreviated, ddx or DDx). For computer diagnosos, see VisualDx and DisagnosisPro, D-dimer        D-dimer is a fibrin degradation product, a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrinogen protein.D- dimer concentration may be determined by a blood test to help diagnose thrombosis. D-dimmer        D-dimer is a fibrin degradation product, a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrinogen protein. D- dimer concentration may be determined by a blood test to help diagnose thrombosis. ded        Deductible Deductible        The amount an insured member must pay before the insurance company pays benefits. Deductibles        The amount that the insured must pay out-of-pocket before the health insurer pays its share.  See Health Insurance and high-deductible health plan (HDHP) DEXA        See DXA DEXA        Dual energy X-ray absorptiometry (DXA, previously DEXA) is a means of measuring bone mineral density (BMD). Two X-ray beams with differing energy levels are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by bone. Dual energy X-ray absorptiometry is the most widely used and most thoroughly studied bone density measurement technology. DHCS        Division of Health Care Services, see Medicaid DHP        Discount Health Plans – These programs vary by state and in some circumstances may be offered by physicians and/or independent brokers.  Discount health plans are not health insurance. Usually these are membership plans that purport to offer savings on doctor and hospital visits and on prescription drugs. Many discount health plans are marketed door-to-door, via telemarketing, unsolicited facsimiles, and by posting advertisements in local neighborhoods. You should be extremely careful before signing up for a non-insurance discount health plan, especially before you cancel existing insurance coverage. DICOM        Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. The communication protocol is an application protocol that uses TCP/IP to communicate between systems. DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format. DM        diabetes mellitus DME        Durable medical equipment is a term used to describe medical equipment used in the home to aid in a better quality of living. It is a benefit included in most Insurances. In some cases certain Medicare benefits, that is, whether Medicare may pay for the item. DNAP        Doctor of Nurse Anesthesia Practice DNP        Doctor of Nurse Practice - A degree that focuses on the clinical aspects of nursing rather than academic research. The curriculum for the DNP degree generally includes advanced practice, leadership, and application of clinical research. The DNP is intended primarily to prepare registered nurses to become advanced practice registered nurses. Advanced practice roles in nursing include the nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), and the clinical nurse specialist (CNS). Although approximately 52% of nurse anesthetist programs will award the DNP, the remaining 48% may use the title Doctor of Nurse Anesthesia Practice (DNAP) for their terminal degree. DOS        Date of Service DPA        Division of Public Assistance, see Medicaid DPC        Direct Primary Care - Direct primary care practices are an offshoot of the retainer care model, which provides unlimited or less-restricted access to physicians for a set fee. Under direct primary care, patients typically pay a monthly fee for unlimited access to a range of primary care services. Ref1, Ref2 DRE        Digital Rectal Examination DRG        Diagnosis-Related Groups Drug schedules        Schedule I  -n a category of drugs not considered legitimate for medical use. Included are heroin, lysergic acid diethylamide (LSD), and marijuana. Schedule II - n a category of drugs considered to have a strong potential for abuse or addiction but that also have legitimate medical use. Included are opium, morphine, and cocaine. Schedule III - n a category of drugs that have less potential for abuse or addiction than Schedule I or II drugs and have a useful medical purpose. Included are short-acting barbiturates and amphetamines. Schedule IV - n a medically useful category of drugs that have less potential for abuse or addiction than those of Schedules I, II, and III. Included are diazepam and chloral hydrate. Schedule V - n a medically useful catiegory of drugs that have less potential for abuse or addiction than those of Schedules I through IV. Included are antidiarrheals and antitussives with opioid derivatives Dry needling        Dry needling  is the use of a solid needle for therapy of muscle pain, sometimes also known as intramuscular stimulation. Dry needling contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or corticosteroids to the same point. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue. Analgesia produced by needling a pain spot has been called the needle effect. Acupuncture and dry needling techniques may be similar, but their rationale and use in treatment are quite different. ds        See dx DSMT        Diabetes Self-Management Training DTaP        A vaccine combination that includes: vaccine for diphtheria, tetanus, pertussis.  There are two nearly identical names for these vaccine combinations.  The common childhood combination is DTaP.  The newer booster vaccine for older children and adults is Tdap DTCA        Direct-To-Consumer Advertising (DTC advertising) usually refers to the marketing of pharmaceutical products but can apply in other areas as well DV        Domestic Violence DVT        Deep Vein Thrombosis, also see CDT and PTS, Ref 1 DVT        Deep Venous Thrombosis is the formation of a blood clot in a vein that is deep inside a part of the body, usually the legs.  Also see VTE and PE DVT        Deep Venous Thrombosis DX        Delta Exchange DX, dx        Diagnosis, the determination of the nature of a disease. DX may alternatively be written Dx or dx. DXA        Dual-energy X-ray absorptiometry, (previously DEXA) is a means of measuring bone mineral density (BMD). Two X-ray beams with different energy levels are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by bone. Dual-energy X-ray absorptiometry is the most widely used and most thoroughly studied bone density measurement technology. The DXA scan is typically used to diagnose and follow osteoporosis. It is not to be confused with the nuclear bone scan, which is sensitive to certain metabolic diseases of bones in which bones are attempting to heal from infections, fractures, or tumors. dxic        diagnostic DynaMed        DynaMed is reference site developed around the diagnosis for a particular question you have and then broken down by diagnosis, treatment, etc.   Often you can find information more quickly than at other sites,  Can be used to quicly find information while with patient.  By comparison:   UpToDate is a reference site but information with information presented in article format so the information you want may take time to locate..  Upside is CME.   MDConsult is another nice reference site that offers more history.  Queries bring up current journals, books (quite a wide array) and patient education (also in Spanish).  You can search each of the reference type separately or all together. I think of it more of a user friendly Medline Resource with 'easily' accessible content.   MEDLINE contains journal citations and abstracts for biomedical literature from around the world.  PubMed® provides free access to MEDLINE and links to full text articles when possible. E&M or (E/M)        Evaluation and Management EAP        Employee Assistance Program EBM        Evidence Based Medicine (Also see NNT) ECG        Electrocardiography (ECG or EKG) is a transthoracic interpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes.[ ED        Emergency Department EFT        The Patient Protection and Affordable Care Act required standards be adopted for EFT. Rather than add EFT to the Health Insurance Portability and Accountability Act (HIPAA) rules as a separate transaction, HHS amended the existing “healthcare payment and remittance advice” standard to include EFT. The new standards cover only the “payment initiation” from a health plan to its financial institution, not the bank’s transfer to the recipient provider’s bank. No later than January 1, 2014, all health plans must submit electronic healthcare payments to providers in the Corporate Credit or Debit Plus (CCD+) uniform standard. NACHA (previously known as the National Automated Clearing House Association) manages the development, administration, and governance of the Automated Clearing House (ACH) Network. This network is at the core of electronic movement of money and data in the United States. The CCD+ standard contains an addenda record that will allow providers to associate their payments back to their electronic remittance advices (ERA) (ASC X12N 835 transactions).  The EFT trace number in the CCD+ (Record 7, Field 3) will match back to the EFT trace number in the TRN02 (Reassociation Trace Number) segment in the header of the 835. However, it will not display on the Blue Cross and Blue Shield of Alabama paper remittance image. For ProviderAccess users, the EFT trace number can be found in the Payment History response from the Payee Functions menu under Payment Information.  Blue Cross will begin converting their current EFT CCD standard to the CCD+ standard by end of March 2013 and will complete the transition by the end of April 2013. Due to the change of format, the 10-character header record which currently displays as “EFT PAYROL” will display as “HCCLAIMPMT” in the CCD+ EFT transaction. As stated above, only the transmission of EFT from the health plan to its financial institution is addressed in this rule. Therefore, if a provider would like to view this trace number, they will need to contact their financial institution to request it be viewable in their EFT notifications.  Ref1 EFT        Electronic Funds Transfer – See Medicare Authorization Agreement for Electronic Funds Transfers (EFT) Form (CMS-588). This form is used to submit necessary information for the initiation of electronic funds transfers of Medicare remittances.  The following hints should assist you in correctly completing this form. EGD        Esophagogastroduodenoscopy - a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anesthesia has been used). A sore throat is also common.[ EGWP        Employer Group Waiver Plans EHR        Electronic Health Record – A term generally used for "electronic health record" software used by doctors and hospitals, often replacing older term EMR, or electronic medical record. Often confusing, as some people use EHR to mean the content or output of a software program, rather than the software application itself. EHR        An EHR is a patient centric application where long-term and aggregate health information from one or more encounters in any health care delivery setting is stored.  Because an EMR only stores data from a particular hospital or practice, an EHR allows a patient to store data from any health care delivery encounter. EHRVA        Electronic Health Record Vendors Association EKG        See ECG EMR        An EMR is an application used by Doctors (HCPs) and other clinicians to store, organize, and access all patients’ clinical data for a particular hospital or practice.  In other words, the application used by an entire practice or hospital to legally store patient records electronically. EMT        Emergency Medical Technician EMTALA        Emergency Medical Treatment and Active Labor Act – An. Act of Congress passed in 1986. It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment. EOB        Explanation of Benefits  - A statement describing medical benefits and account activity, including explanation of why certain claims may or may not have been paid. ePHI        Electronic Protected Health Information EPM        Enterprise Practice Management ePrescribing        Electronic Prescribing. See the E-Prescribing Readiness Assessment at GetRxConnected.org.   See:  http://www.surescripts.com/, Also see MIPPA, E-prescribing How ePrescribing works,  See more at Surescripts ER        Extended-release, , also see ER/LA opioid analgesics ERA        Electronic Remittance Advice (ERA) is an electronic version of the Standard Paper Remittance (SPR) ERA        Electronic Remittance Advice eRx        See ePrescribing ETOH        An abbreviation for ethanol (i.e. alcohol). For instance, "ETOH 10g/day" denotes that the patient drinks 10 grams (or roughly one standard drink) of alcohol a day on average. ETT        Exercise Treadmill Test Exclusion        Services or supplies not covered under a health plan. f/u        follow-up on FAAFP        Fellow of the American Academy of Family Physicians.  See AAFP FACA         Federal Advisory Committee Act Facility fee         Facility fees are charged to cover the expenses due to staff other than the physician, such as nurses, and for office rent and other overhead. Ref1 Fee Schedule        A listing of the maximum fee which a health plan will pay for services based on CPT billing codes. FEP        Federal Employee Program FERPA        Family Educational Rights and Privacy Act , at: http://www.hhs.gov/ocr/hipaa/. FFNCS        Fees For Non Covered Services (see article), see NCBF, see TANCS FFS         Fee for Service - a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. FH        Family History FMCSA        Federal Motor Carrier Safety Administration – See Commercial Driver’s License (CDL) FMLA        Family and Medical Leave Act - The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to: Twelve workweeks of leave in a 12-month period for: 1. The birth of a child and to care for the newborn child within one year of birth; 2. The placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement; 3. To care for the employee’s spouse, child, or parent who has a serious health condition;  4. A serious health condition that makes the employee unable to perform the essential functions of his or her job;  5.  Any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” or  Twenty-six workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness who is the spouse, son, daughter, parent, or next of kin to the employee (military caregiver leave). FNCS        Fee for non-covered services (see article), see NCBF, see TANCS.  Also see FFNCS FOBT        fecal occult blood tests FOFM        Future of Family Medicine FQHC        Federally Qualified Health Center. In many parts of the country FQHCs are paid much more per Medicaid patient visit than a physician in private practice.  More at Rural Health Clinic (RHC) Fragmented billing        Fragmented billing or unbundling is the use of more than one procedure code to bill for a procedure or service that may be adequately described by a lesser number of codes. free, free PSA        See PSA frequency of medication        See:   bid - twice a day   tid - three times a day   qd - taken daily   qid - four times a day   q_h - taken every so-many hours    FSA        Flexible Spending Account (FSA) - An FSA is an account that employers set up for employees to help offset the costs of medical and dependent care costs. Contributions are put in solely by employees but contribution limits for the health care account are set by the employer. Functional medicine        Functional medicine is a form of Western alternative medicine unrelated to the Western biomedical approaches.  It focuses on treating individuals who may have bodily symptoms, imbalances and dysfunctions. Functional medicine seeks to identify and address the root causes of disease, and views the body as one integrated system, not a collection of independent organs divided up by medical specialties. Functional medicine practitioners provide chronic care management with the belief that "diet, nutrition, and exposure to environmental toxins play central roles in functional medicine because they may predispose to illness, provoke symptoms, and modulate the activity of biochemical mediators through a complex and diverse set of mechanisms GAD        Generalized Anxiety Disorder GAD-7        Generalized Anxiety Disorder 7 (abbreviated as GAD-7) is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder (GAD).[1] GAD-7 has seven items, which measure severity of various signs of generalized anxiety disorder according to reported response categories of “not at all,” “several days,” “more than half the days,” and “nearly every day.” Assessment is indicated by the total score, which made up by adding together the scores for the scale all seven items. GAD-7 is a sensitive self-administrated test to assess generalized anxiety disorder, however it cannot be used as replacement for clinical assessment and additional evaluation should be used to confirm a diagnosis of GAD. GBS        Guillain-Barré syndrome is an acute, immune-mediated paralytic disorder of the peripheral nervous system.   (See article) GDM        Gestational Diabetes Mellitus Genetic testing        Genetic testing, more at NIH GERD        GastroEsophageal Reflux Disease is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach).  See: Risks of GERD Treatments GFR        Glomerular filtration rate GGT        Gamma glutamyl transpeptidase - A test to detect liver disease. The GGT test helps to detect liver and bile duct injury. While some doctors use it in all people they suspect of having liver disease, others use it only to help explain the cause of other changes or if they suspect alcohol abuse. Gomco        A Gomco clamp, otherwise known as a Yellen clamp is a specialized clamp for performing circumcisions. H & P        History and Physical (examination) HBMA        Healthcare Billing and Management Association HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems – Questionnaire used by Medicare to measure quality HCC        Medicare implemented an Hierarchical Condition Categories model in 2004 to adjust capitation payments to private health care plans for the health expenditure risk of their enrollees.  The Centers for Medicare and Medicaid (CMS) Risk Adjustment Model measures the disease burden that includes 70 HCC categories, which are correlated to diagnosis codes. See more at HCCuniversity and HCCblog HCC        Hierarchical Condition Categories – See Risk Adjustment Factor (RAF) HCFA        Health Care Financing Administration – Is now called Centers for Medicare & Medicaid Services (CMS). HCFA was renamed the Centers for Medicare and Medicaid Services (CMS) on June 14, 2001. HCFA        Health Care Financing Administration HCFA-1500        The CMS HCFA-1500 form is the standard paper claim form used by a non-institutional provider or supplier to bill Medicare carriers and Medicare administrative contractors (MACs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. The form is also used to bill Medicaid State Agencies. See MDCodeWizard HCFA-1500        A form developed by the Health Care Financing Administration to be used by health care providers to bill health carriers HCG        Human chorionic gonadotropin (HCG) is a hormone that is normally produced first by the cells that make up the placenta, then later by the placenta during pregnancy. Its primary function is to support the pregnancy by encouraging the production of progesterone. This supports and promotes the further development of the placenta early in pregnancy. HCG sees a rapid increase early in pregnancy, but tapers off slowly as the placenta can produce enough progesterone to support the pregnancy on its own. The hormone also serves in aiding in the development of gonads in the fetus and the production of androgens by the testes of a male fetus.  Levels of HCG can first be detected approximately 11 days following conception, in a blood test. One to three days later, HCG can be detected with a urine test. Some highly sensitive tests can detect HCG as early as a week following ovulation. Normal home pregnancy tests are not able to detect HCG in the blood until at least 12 to 14 days after ovulation. HCP        Health Care Provider HCPCS        Healthcare Common Procedure Coding System (HCPCS) is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT). Commonly pronounced Hick-Picks. Healthcare Procedure Coding System. HCPCS includes three levels of codes: •        Level I consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric. •        Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices[2], and represent items and supplies and non-physician services not covered by CPT-4 codes (Level I). Level II alphanumeric procedure and modifier codes are a single alphabetical letter followed by 4 numeric digits; the first alphabetic letter is in the A to V range. Level II codes are maintained by the US Centers for Medicare and Medicaid Services (CMS). There is some overlap between HCPCS codes and National Drug Code (NDC) codes, with a subset of NDC codes also in HCPCS, and vice-versa. The CMS maintains a crosswalk from NDC to HCPCS in the form of an Excel file. The crosswalk is updated monthly. •        Level III codes, also called local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. The use of Level III codes was discontinued on December 31, 2003, in order to adhere to consistent coding standards. NDC and HCPCS Frequently Asked Questions,   CMS Web Site Health 2.0        Health 2.0 is a terms representing the possibilities between health care, eHealth and Web 2.0 Healthcare        An approach to delivery of medical services that emphasizes preventative medical care as opposed to “sick-care.” HEAP        History (equivalent to Subjective in SOAP format), Physical Examination (equivalent to Objective in SOAP format), Assessment (Assessment or Impression), Plan.  This is also called HPIP.  Also see SOAP HEDIS        Healthcare Effectiveness Data and Information Set (HEDIS) is a tool created by the National Committee for Quality Assurance (NCQA) to collect data about the quality of care and services provided by the health plans. HEDIS consists of a set of performance measures that compare how well health plans perform in key areas: quality of care, access to care and member satisfaction with the health plan and doctors. NCQA requires health plans to collect this information in the same manner so that results can be fairly compared to one another. Health plans can arrange to have their HEDIS results verified by an independent auditor. HEENT        Head, Eyes, Ears, Nose, and Throat Hello Health        Hello Health an EHR that offers to generate revenue. Opinion: It appears to be a concierge style, cash only, technology-driven practice with a low monthly fee that's designed to make it accessible for most patients. Seems like it would have some of the advantages of concierge-style medicine for folks who don't particularly like dealing with the overly-entitled rich patients that some concierge practices attract. Note: Gordon Moore is involved with training component in "Hello Health University." HHS        Department of Health and Human Services of the U.S. government. The Secretary of HHS is a cabinet level position, and is currently occupied by Kathleen Sibelius, former governor of the state of Kansas. HIAA        Health Insurance Association of America HIE        Health Information Exchange HIMSS         Healthcare Information and Management Systems Society – A trade group that represents 350 companies and about 20,000 members. Corporate members include government contractors such as Lockheed Martin and Northrop Grumman, health-care technology giants such as McKesson, Ingenix and GE Healthcare, and drug industry leaders, including the Pharmaceutical Research and Manufacturers of America.  HIMSS has a "strategic alliance" with the Center for Information Technology Leadership, a nonprofit that produces research reports -- which HIMSS prints and distributes to Congress and elsewhere HIPAA        Health Insurance Portability and Accountability Act of 1996 Resources: U.S. Department of Health & Human Services http://www.hhs.gov/ocr/hipaa/ Indian Health Service http://www.ihs.gov/AdminMngrResources/PrivacyAct/index.cfm?module=pao_medrec_qa#20: Center for Medicare and Medicaid Services Security Education Materials http://www.cms.hhs.gov/EducationMaterials/04_SecurityMaterials.asp Jones, G. Maryland Family Doctor HIPAA in the Practice. http://www.mdafp.org//publications/newsletter/MAFQ_0109_final.pdf http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/ HIPAA 5010 Transaction Standard        HIPAA 5010 Transaction standard becomes effective 1n 2012 and will accommodate ICD 10 codes.  Other changes physician practices should take note of are: You may continue to use a P.O. Box address in the "pay to" information on your claims but a physical address is required in the billing provider information (the 2010AA loop). You must include 9-digit zip codes with billing and service facility locations. Version 5010 will include a pay to plan loop (2010AC) that allows addition of information about a payer that has paid a claim under subrogation rules. Up to 12 diagnosis codes may be submitted on a claim. A paperwork section of the claim will notify Medicare that you are sending additional documentation to support a claim and an ID number of your choosing that will connect the claim and the documentation. Your Medicare Administrative Contractor (MAC) will provide a cover sheet for faxing or mailing the documentation to them. The ID number you assigned in your claim will be included on the cover sheet so that the documentation can be added to the claim.   (Ref1), 5010 FAQs & Tips HIT         Health Information Technology HIT Policy Committee        Committee given mandate to shape the new HITECH policies HITECH        Health Information Technology for Economic and Clinical Health act passed as part of the American Recovery and Reinvestment Act of 2009 (ARRA).  That portion of ARRA that specifically covers the EHR incentive program, and other health IT related grants and programs.  Interim Final Rule (Dec 30, 2009) HITSP        Healthcare Information Technology Standards Panel HL7        Data standard for import/export form EMRs  (See AAFP Slides about issues/problems), (Comparison of HL7 and XML, page 26) HMG        Health Maintenance Guidelines HMO        Health Maintenance Organization Holter Monitor        A Holter Monitor is a  portable device for continuously monitoring various electrical activity of the central nervous system for at least 24 hours. The most common use is for monitoring the heart or ECG, but can also be used for monitoring EEG. Its extended recording period is sometimes useful for observing occasional cardiac arrhythmias or epileptic events (EEG) that would be difficult to identify in a shorter period of time. HPC        Hospice Palliative Care HPI        History of Present Illness HPIP        History, Physical, Impression, Plan (Same as HEAP) HPSA        Health Professional Shortage Areas HRA        Health Reimbursement Account (HRA) - Employers set up HRAs for employees, usually in conjunction with another plan. The amount is set by the employer. Employees can use money from this account to pay for qualified medical expenses such as premiums, co-insurance, deductibles and services. HRA        Health Reimbursement Arrangement - an employer-funded arrangement in which each participant has an individual account for the payment of insured or self-insured medical care. Ref1 HRA        Health Risk Assessment, CMS guidance. See list of the 34 elements that must be included in the HRA. Also FPM toolbox - Wellness care – Medicare checkup HRSA        Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable. HRSA oversees organ, bone marrow and cord blood donation. It supports programs that prepare against bioterrorism, compensates individuals harmed by vaccination, and maintains databases that protect against health care malpractice and health care waste, fraud and abuse. HSA        Health Savings Account (HSA) - Both an employer and employee can contribute to an HAS. An HSA is only used with a high deductible health plan. No matter who contributes, all contributions are made on a pre-tax basis. HSA        Health Savings Account HT        Hypertension HTN        Hypertension HWIC        Health Workforce Information Center, or HWIC. – This site aims to deliver information that assists health professionals, educators, researchers and policymakers in developing strategies to meet future workforce demands. Family physicians interested in keeping abreast of health care workforce changes and health personnel shortages have a new, centralized online library they can hyfrecator        A hyfrecator is a low-powered medical apparatus used in electrosurgery. Opinion: Creates a plume of virus in the room. Although there is little risk to the patient as a 1 time dose.  Multiple exposures to operator can lead to warts in the larynx and, at worst, squamous cell carcinoma of the throat. HYH        How’sYourHealth.org – Patient questionnaire used by IMPs.  HYH measures care attributes that affect outcomes: access, efficiency , continuity, information, and the road to confidence. ICD        International Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. Every health condition can be assigned to a unique category and given a code, up to six characters long. Such categories can include a set of similar diseases.   (Online reference).  Each year, CMS releases a list of ICD-9 updates that go into effect October 1. ICD - E Codes        External causes of injury ICD-  G Codes         ICD - V Codes        The miscellaneous V codes capture a number of healthcare encounters that do not fall into one of the other categories. (article) ICD-10        An International Classification of Diseases.      ICD-10-PCS International Classification of Diseases, 10th Revision, Procedure Coding System.      ICD–10–CM International Classification of Diseases, 10th Revision, Clinical Modification. Work on ICD-10 began in 1983 and was completed in 1992. Adoption was relatively swift in most of the world, but not in the United States. Since 1988, the USA had required ICD-9-CM codes for Medicare and Medicaid claims, and most of the rest of the American medical industry followed suit. HHS announced that it would extend the implementation deadline for the International Classification of Diseases, 10th Revision, Clinical Modification, or ICD-10-CM, for outpatient diagnosis coding, to Oct. 1, 2013. ICD-10-CM        See ICD-10. ICD-10-CM provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), for medical coding and reporting in the United States. The ICD-10-CM is a morbidity classification for classifying diagnoses and reason for visits in all American health care settings. ICD-10-PCS        See ICD-10. ICD-10-PCS is an American system of medical classification used for procedural codes. The National Center for Health Statistics (NCHS) received permission from the World Health Organization (WHO) (the body responsible for publishing the International Classification of Diseases [ICD]) to create the ICD-10-PCS as a successor to Volume 3 of ICD-9-CM and a clinical modification of the original ICD-10 ICD-11        See ICD.  Planned for 2015 [1] and will be revised using Web 2.0 principles ICD-9        ICD-9 is a 3 to 5-digit number code describing a diagnosis or medical procedure.   Article  The ICD-9 was published by the WHO in 1977. At this time, the U.S. National Center for Health Statistics created an extension of it so the system could be used to capture more morbidity data and a section of procedure codes was added.[3] This extension was called "ICD-9-CM", with the CM standing for "Clinical Modification".  ICD9 update for 2011 ICD-9 (vendors)        Access ICD-9-CM Coder 4.0, If you need to look up ICD-9 codes, the following resources work so well that you probably never need to buy a ICD-9 coding book. - The Flash Code website allows free use of its ICD-9 reference guide. - Another free ICD-9 lookup site is icd9data.com. It has a search function and ICD-9 data for previous years. - Alternatively, you can do a Google search for "ICD9" and a diagnosis name. ICE        Integrated Community EHR IFR        Interim final rule, another way that agencies of the federal government publish regulations, but when they are on a fast track and there is urgency, essentially by-passing the NPRM stage. IHI        Institute for Healthcare Improvement – Organization involved in healthcare reform with focus on larger organizations.  See Essay dated 12/10/2009 on IHI vs. IMP approach. IMG        International Medical Graduate IMH        Instant Medical History, See Articles, Also see CHADIS immunization        http://www.immunize.org/ IMO        Intelligent Medical Objects – a product that provides coding help IMO        In my opinion (Internet slang) IMP        Ideal Medical Practice -  The term, Ideal Micro Practice was originally coined to describe the smallest functional work unit* in medical office practices capable of delivering superb care in a vital and sustainable environment. However, the acronym, IMP, has since been expanded to refer to the Ideal Medical Practice in order to emphasize that the delivery of superb care is not necessarily limited to care provided by solo physician practices.  Also see Ideal Medical Practices project, IMP Wiki,  links to previous articles written about IMPs, In-Network Provider        Physicians and other service providers who are contracted with a managed care plan. Inpatient        A patient who is admitted to a hospital and receives medical services from a physician during at least a 24-hour period. INR        International Normalized Ratio is a laboratory test that measures the amount of time it takes for blood to clot and compares it to an average. People on blood thinning drugs (such as Warfarin) would normally have this test done on a fairly regular basis. INRatio        See INR Integrative Medicine        Integrative medicine or integrative health is a neologism coined by practitioners to describe the combination of practices and methods of alternative medicine with conventional medicine.[1][2][3] Some universities and hospitals have integrative-medicine departments.[3] The term has been popularised by, among others, Deepak Chopra, Andrew Weil and Prince Charles.[4] In the UK, the universities of Buckingham and Westminster have previously offered courses in integrative medicine, for which they have received much criticism. Integrative Medicine        Textbook of Natural Medicine by Pizzorno and Textbook of Functional Medicine.  Integrative medicine InterQual        Tool to ensure that care delivery is evidence based (McKesson), (History behind the product) InterQual® criterion        See McKesson Information Solutions IOM        Institute of Medicine IPA        Independent Practice Association IPA        Independent Physician Association IPAB        Independent Payment Advisory Board - The Senate health reform bill established a 15-member Independent Payment Advisory Board (IPAB) with significant authority with respect to Medicare payment rates. Beginning in 2014, in any year in which the Medicare per capita growth rate exceeded a target growth rate, the IPAB would be required to recommend Medicare spending reductions.  The recommendations would become law unless Congress passed an alternative proposal that achieved the same level of budgetary savings. Article: Medicare IPAB: Rational or rationing IPPE        Medicare Initial Preventive Physical Examination. (Ref1), (Ref2). Congress expanded the preventive care benefits available under Medicare Part B beginning January 2011. In addition to the existing Welcome to Medicare visit (or Initial Preventive Physical Exam, IPPE) for new Part B beneficiaries, Medicare now also offerss an annual wellness visit (AWV) for personal prevention plan services. IPPS        Integrated Physician Practice Section of the AMA’s House of Delegates.  The IPPS addresses the issues facing physicians in group and integrated practices.  The IPPS is intended to enable physicians from multispecialty, physician-led, integrated health care delivery, along with groups actively working toward such systems, to have an official vote in the AMA policymaking process. IS        Intensity of Service JACO        See JCAHO JCAHO        The Joint Commission on Accreditation of Healthcare Organizations (pronounced "Jay-co") was established in 1951 under the name "Joint Commission on Accreditation of Hospitals" (JCAH) for the purpose of setting safety standards within hospitals. By 1981, the organization's reviews included other health care organizations such as home care and hospice agencies. The name was changed to include the other "healthcare organizations".   Reference 1, Joint Commission        Joint Commission - An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’ s commitment to meeting certain performance standards. KDOQI        The National Kidney Foundation (NKF) Disease Outcomes Quality Initiative (KDOQI) provides evidence- based clinical practice guidelines for chronic kidney disease (CKD) and related complications. L&D Nurse        Registered nurses provide care to women and their newborns during the antepartum, intrapartum, postpartum, and neonatal stages LA        Long-acting, also see ER/LA opioid analgesics LAHB        Left Anterior Hemiblock. See ETT LBBB        Left Bundle Branch Block - a cardiac conduction abnormality. See ETT LCD        Local Coverage Determinations - An LCD, as established by Section 522 of the Benefits Improvement and Protection Act, is a decision by a fiscal intermediary or carrier whether to cover a particular service on an intermediary- wide or carrier-wide basis in accordance with Section 1862(a)(1)(A) of the Social Security Act (i.e., a determination as to whether the service is reasonable and necessary). The difference between LMRPs and LCDs is that LCDs consist only of "reasonable and necessary" information, while LMRPs may also contain category or statutory provisions. The final rule establishing LCDs was published November 11, 2003. Effective December 7, 2003, CMS's contractors will begin issuing LCDs instead of LMRPs. Over the next 2 years (until December 31, 2005) contractors will convert all existing LMRPs into LCDs and articles. Until the conversion is complete, for purposes of a 522 challenge, the term LCD will refer to both 1.) Reasonable and necessary provisions of an LMRP and, 2.) an LCD that contains only reasonable and necessary language. Any non-reasonable and necessary language a contractor wishes to communicate to providers must be done through an article. Also see MCD LCD        Local Coverage Determination  - provides a CMS guide to assist in determining whether a particular item or service is covered LCP        Limited Care Practitioner – A medical specialist with limited focus that may blind them to the big picture. Also called Partialist LCSW        Licensed Clinical Social Workers (LCSW) LGBT        LGBT An initialism that collectively refers to the lesbian, gay, bisexual, and transgender community. LGHIP        Local Government Health Insurance Plan lipids        Lipids are broadly defined as any fat-soluble (lipophilic), naturally-occurring molecule, such as fats, oils, waxes, cholesterol, sterols, fat-soluble vitamins (such as vitamins A, D, E and K), monoglycerides, diglycerides, phospholipids, and others. LMWH        Low Molecular Weight Heparin LOINC         Logical Observation Identifiers Names and Codes - a database and universal standard for identifying medical laboratory observations.  Since its inception, the database has expanded to include not just medical and laboratory code names, but also: nursing diagnosis, nursing interventions, outcomes classification, and patient care data set.  Reference 1 LOON        Low Overhead Out of Network -  A variant on the IMP style practice.  Typically do not take insurance, charge for email consults, after hours calls.  See book by Dr. Daphne and her practice's website. LPN        Licensed practical nurse (LPN) is the term used in much of the United States and most Canadian provinces to refer to a nurse who cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians. The term licensed vocational nurses (LVN) is used in California and Texas. LVN        See LPN MA         Medicare Advantage MAC        Medicare Administrative Contractor MAPD        Medicare Advantage Prescription Drug plan MAR        Medication Administration Records MASM        Medical Association of the State of Alabama MCD        The Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions. The database also includes several other types of National Coverage policy related documents, including National Coverage Analyses (NCAs), Coding Analyses for Labs (CALs), Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) proceedings, and Medicare coverage guidance documents. McKesson Information Solutions         MCO        Medicare Managed Care Organization (MCO) MDConsult        MDConsult - A reference site that has often has more more history.  Queries bring up current journals, books (quite a wide array) and patient education (also in Spanish).  You can search each of the reference type separately or all together. See DynaMed MDM        Medical Decision Making (MDM) is divided into three areas: number of diagnoses and management options, amount and complexity of data reviewed, and risk of complications, morbidity or mortality. Meaningful Use        Under the ARRA/HITECH legislation, physicians and hospitals will be eligible to receive incentive payments for the "meaningful use of certified EHR technology." Meaningful use is described and its criteria give in the NPRM referenced here. Preamble (June 2009),  Overview Article,    "Meaningful use" will be phased in during the next several years in the following three (3) stages: Stage 1: Data Capture and Sharing — The goal is to electronically capture data in coded format as well as to report health information usable for tracking key clinical conditions. Stage 2: Advanced Clinical Processes — The goal is to guide and support care processes and care coordination through the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry and the electronic transmission of diagnostic test results (e.g. blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests, and other such data needed to diagnose and treat disease). Proposed Rule Stage 3: Improved Outcomes — The goal is to achieve improved performance through the effective adoption and use of care processes as well as advance key health system outcomes. In addition, at this stage, the goal is to promote further improvements in quality, safety, and efficiency by focusing on decision support for national high-priority conditions, patient access to self management tools, improving access to comprehensive patient data, and improving population health. Web links to FTC regulations and Red Flags Rule resources for additional compliance guidance and information. Summaries of meaningful use objectives: HIT News’ List of Meaningful Use Objectives    HISTalk Meaningful Use Matrix (excel file download)    Vitalize Meaningful Use Matrix    Health IT Now Meaningful Use Matrix (PDF)    Galen Healthcare Meaningful Use Matrix (wiki page)    Software Advice Meaningful Use Matrix    GalenHealthCare.com    Software Advice’s Medical blog  (scroll down) Meaningful Use Matrix    Medicaid        See CMS web site) Medical Coordinator        The Medical Coordinator provides a solution to EMR use that frees physician from most data entry task.  The Medical Coordinator approach helps leverage EMR efficiency by using tools such as Skype and an iPad.  See video explanation, See Ref1 Medicare        (See CMS web site) Medicare Advantage        Medicare Advantage - Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the Original Medicare plan (Parts A and B). These programs were known as Medicare+Choice or Part C plans. (notes).   Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MAPD.  The Patient Protection and Affordable Care Act of 2010 will eventually eliminate subsidies to Medicare Advantage plans and bring then in line with Medicare. Medicare Part A        Medicare Part A – Hospital claim Medicare Part B        Medicare Part B – Physician claim Medicare Part C        Medicare Part C combines your Part A and Part B options and must cover all medically needed services. The difference is that private insurance companies that are approved by Medicare provide this type of coverage. (Notes),  See Medicare Advantage Plans. Medicare Part D        The Medicare Part D program provides beneficiaries with assistance paying for prescription drugs. Unlike coverage in Medicare Parts A and B, Part D coverage is not provided within the traditional Medicare program. Instead, beneficiaries must affirmatively enroll in one of many hundreds of Part D plans offered by private companies. (notes).  See Medicare Advantage. Medicine 2.0        See Health 2.0 MEDLINE        MEDLINE - Contains journal citations and abstracts for biomedical literature from around the world.   PubMed provides free access to MEDLINE and links to full text articles when possible. See DynaMed MERSA        MERSA is another name for MRSA or Methicillin-resistant Staphylococcus aureus, a type of bacteria Messenger Model        Messenger model - In contrast to a joint negotiation, the “messenger model” is a process whereby physicians use a common messenger to convey information on fees and fee-related terms that an individual physician is willing to accept.  Also see  Messenger model PHO .  Comment: I belong to this group.  Success for me is: better rates than alone, having an experienced, knowledgeable professional negotiator representing 400 physicians represent me. Success primarily due to competent leadership and administrating. MFCC        Marriage, Family and Child Counselor MFT        Marriage and Family Therapist MHIQ        Medical Home IQ - Find out where you stand on the journey to becoming a Medical Home by measuring your practice against the TransforMED Medical Home IQ Assessment's 9 core sets of competencies or "modules". MI        Myocardial infarction or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium). MIPPA        Medicare Improvement for Patients and Providers Act (MIPPA).  Prescribers who use a qualified system to prepare and send electronic prescriptions at the rate defined by MIPPA can receive higher levels of reimbursement under Medicare.  A qualified system must be able to do all of the following: •        Generate a complete medication list that incorporates data from pharmacies and benefit managers (if available) •        Select medications, transmit prescriptions electronically* using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations •        Provide information on lower-cost, therapeutically appropriate alternatives (for 2009, tiered formulary information, if available, meets this requirement). •        Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan MJ        Marijuana MLR        Medical Loss Ratio - the proportion of health care insurance premium dollars spent on health care claims MMSL        ? EMR data standard MNT        Medical Nutrition Therapy MOC        Maintenance of Certification - In 2001 the American Board of Medical Specialties voted unanimously to expand on and replace recertification programs with Maintenance of Certification (MOC) programs - more comprehensive programs to assess the ongoing competence of physician specialists and their ability to provide quality health care in six general competencies.  In the past, the certification process required successful completion of an approved educational program, an unrestricted medical license as evidence of professional standing, and passing the certification examination. Now medical professionals can no longer simply take an exam to renew a certificate; lifelong learning must be documented. MOCA        Montreal Cognitive Assessment- The MoCA test is a one-page 30-point test administered in approximately 10 minutes. The test and administration instructions are freely accessible for clinicians at www.mocatest.org. The test is available in 35 languages or dialects. There are 3 alternate forms in English, designed for use in longitudinal settings. Ref1, Ref2, MMSE and SLUMS are alternate assessments Mohs        Micrographic surgery - Frequently used for basal cell, squamous cell carcinomas and locally recurrent skin cancers, offering cure rates of 95 to 97 percent.  Mohs surgery is unique in its precision.  Instead of removing the whole clinically visible tumor and a large area of normal-appearing skin around it, the Mohs surgeon removes the minimum amount of healthy tissue and totally removes the cancer.  Thin layers of tissue are systematically excised and examined under a microscope for malignant cells.  When all areas of tissue are tumor-free, surgery is complete. MOL        Maintenance of Licensure Morbidity        The relative incidence of a particular disease.  The ratio of deaths in an area to the population of that area; expressed per 1000 per year MOST        Medical Orders On Life-Sustaining Treatment (See POLST) MPFS        Medicare Physician Fee Schedule - MRSA        Methicillin-Resistant Staphylococcus Aureus, a type of bacteria that can cause skin infections. Although once limited to people with weak immune systems in hospitals and nursing homes, they are increasingly being seen in healthy adults and children.  Also called MERSA. MSA        Medical Savings Account (MSA) - The MSA is for self-employed people and certain small businesses only. MSA holders must also have access to a high deductible health plan. It is set up with a bank or other financial institution to set aside money for future qualified medical expenses. MSW        Medical Social Worker (MSW) or Master's degree in Social Work (MSW) MTIA         Medical Transcription Industry Association MU        Meaningful Use (See ARRA/HITECH) MUA        Medically Underserved Areas Myer’s cocktail        Myers' cocktail is the colloquial name for a nutrient cocktail invented by John Myers, a physician from Baltimore, Maryland, and developed by Alan R. Gaby, administered intravenously and promoted as an alternative treatment for a broad range of conditions including asthma, fibromyalgia and chronic fatigue syndrome. NACCHO        National Association of County and City Health Officials - Non-profit association serving 3000 local health departments NACHA        The National Automated Clearing House Association manages the development, administration, and governance of the ACH Network, the backbone for the electronic movement of money and data in the United States.   See EFT. NAHIT         National Alliance for Health Information Technology NBME        National Board of Medical Examiners NCBF        Non Covered Benefits Fee,  see FFNCS, (see article), see TANCS NCCI        National Correct Coding Initiative - CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association's CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual).  The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits.  See cms.hhs.gov/NationalCorrectCodInit NCD        National Coverage Determinations - An NCD sets forth the extent to which Medicare will cover specific services, procedures, or technologies on a national basis. Medicare contractors are required to follow NCDs. If an NCD does not specifically exclude/limit an indication or circumstance, or if the item or service is not mentioned at all in an NCD or in a Medicare manual, it is up to the Medicare contractor to make the coverage decision (see LMRP). Prior to an NCD taking effect, CMS must first issue a Manual Transmittal, CMS ruling, or Federal Register Notice giving specific directions to our claims-processing contractors. That issuance, which includes an effective date and implementation date, is the NCD. If appropriate, the Agency must also change billing and claims processing systems and issue related instructions to allow for payment. The NCD will be published in the Medicare National Coverage Determinations Manual. An NCD becomes effective as of the date listed in the transmittal that announces the manual revision.  Also see MCD NCPDP        National Council for Prescription Drug Programs – Provides a wide range of standards for communicating pharmacy information electronically. NCPDP provides standards for transmitting prescription information to the prescription clearinghouse (Surescripts).  See SCRIPT NCPDPID        The NCPDP Provider Identification Number (NCPDP Provider ID) formerly known as the NABP number, was developed over twenty-five years ago to provide pharmacies with a unique, national identifier that would assist pharmacies in their interactions with pharmacy payers and claims processors. The NCPDP Provider ID is a seven-digit numbering system that is assigned to every licensed pharmacy and qualified Non-Pharmacy Dispensing Sites (NPDS) in the United States NCQA        National Committee on Quality Assurance (NCQA) NCS        A nerve conduction study (NCS) is a test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. Nerve conduction velocity (NCV) is a common measurement made during this test. The term NCV often is used to mean the actual test, but this may be misleading since velocity is only one measurement in the test suite. NCSC        AAFP’s National Conference of Special Constituencies NCV        Nerve conduction velocity (NCV) is a common measurement made during a nerve conduction study (NCS). The term NCV often is used to mean the actual test, but this may be misleading since velocity is only one measurement in the test suite.See NCS NCVHS         National Committee on Vital and Health Statistics NDC        National Drug Code - The NDC serves as universal product identifier for human drugs.  The 11 digit code has the format 5digits-4digits-2digits.  The code is sometimes displayed on packages with fewer than 11 digits (xxx-xxxx-x). If a section of the code on a package doesn’t have enough digits, just add a leading 0 to the start of that section missing enough digits.  For example, 123-456-7 should be 00123-0456-07 and is usually submitted to automated billing systems without dashes as 00123045607.   NDC and HCPCS Frequently Asked Questions   FDA   Medicare crosswalk   Total Health Care NeHC        National eHealth Collaborative new patient        A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years". For example, if a patient came in for a flu shot by a nurse and did not provide and bill for face-to-face services with physician when the pt got the flu shot, a subsequent physician visit should be billed as a new patient visit.  Reference CPT guidelines for distinguishing between new and established patients. NHIN        Nationwide Health Information Network – (Previously called National Health Information Network)  a set of standards, services and policies that enable secure health information exchange over the Internet. The NHIN will provide a foundation for the exchange of health IT across diverse entities, within communities and across the country, helping to achieve the goals of the HITECH Act. This critical part of the national health IT agenda will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve population health.  As the Office of the National Coordinator (ONC) helps lay the foundation for a Nationwide Health Information Network (NHIN), the challenges for transporting and sharing data have come to light. Even the more-simplified and more-likely-to-succeed version of this, the NHIN Direct, is still a significant undertaking.  Several federal agencies have developed a tool called CONNECT that is intended to address operational details of all this – like locating patients in other organizations, request and receive documents about these patients (after all, each system refers to a given patient in a different way), record these transactions for audit, authenticate network participants, and honor consumer preferences for sharing their information. This collection of tools has been made available as a free open-source toolkit that EHR developers can use to build interoperability in a standardized way. Reference HHS Overview,  The Direct Project    Health Internet is Coming      NHSC        National Health Service Corps NIA        ? something related to denial of a billing claim NIST        National Institute of Standards and Technology: an agency in the Technology Administration that makes measurements and sets standards Test procedure for Immunization Registries   Test procedure for Electronic Prescribing   NKDA        No Known Drug Allergies NLM        National Library of Medicine NMR        Nuclear Magnetic Resonance NMR Lipo profile uses nuclear magnetic resonance spectroscopy to separate out lipid components.  http://www.lipoprofile.com/ NNS        Number Needed to Screen (see NNT) NNT        Number Needed to Treat  - an epidemiological measure used in assessing the effectiveness of a health-care intervention, typically a treatment with medication. The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome (i.e. the number of patients that need to be treated for one to benefit compared with a control in a clinical trial).  For example, one study reported an NNT of 4000 for flu vaccines – indicating a miniscule savings of lives when administered to the general public. You might tell a patient that an NNT of 10 means that the chance that he/she will benefit in this way from the treatment is 1 in 10. For common treatments see estimated NNT at: www.thennt.com To calculate NNT use the NNT calculator. NOC        CPT code that is unlisted or not otherwise classified noctor        A slang term derived from ‘not a doctor’ for a person of varying training and experience who provides some form of health care traditionally performed by a doctor.  Examples: Nurse practitioners, Emergency care technicians NPI        National Physician Identifier, See NPPES. Look up NPIs NPP        Nature of the Presenting Problem NPP        Nurse Practitioner in Psychiatry NPPES        National Plan and Provider Enumeration System (NPPES), Apply for NPI NPRM        Notice of Proposed Rulemaking (NPRM) is issued by law when one of the independent agencies of the United States government wishes to add, remove, or change a rule (or regulation) as part of the rulemaking process. It is an important part of United States administrative law. Example is: NPRM published Dec. 19, 2009, on "meaningful use," interpreting and putting into effect the EHR incentive programs that were included in the stimulus bill, the American Recovery and Reinvestment Act, or ARRA, passed and signed into law in February, 2009. NRMP        National Resident Matching Program NRN        National Research Network  - The AAFP NRN’s mission is to support, conduct and disseminate practice- based primary care research that improves health care and benefits the health of patients, their families and communities.  The Academy created the AAFP NRN in 1999 to fill a void in primary care research left after the Ambulatory Sentinel Practice Network, which had conducted more than two decades of practice-based research, ceased operations.  Ref1. NSAID        Nonsteroidal anti-inflammatory drugs - The most prominent members of this group of drugs are aspirin, ibuprofen, and naproxen NVLAP         National Voluntary Laboratory Accreditation Program OCD        Obsessive–compulsive disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts (obsessions) and behaviors (compulsions). OCIIO        HHS Office of Consumer Information and Insurance Oversight, office tasked with implementing all private insurance reforms enacted in the ACA. OCP        Oral Contraceptive Pill OCR        Office for Civil Rights, also Optical Character Recognition OIG         Office of Inspector General OMB         Office of Management and Budget OMM        Osteopathic Manipulative Medicine OMSS        The AMA Organized Medical Staff Section (See conference notes) ONC         Office of the National Coordinator for Health Information Technology ONCHIT        Office of the National Coordinator for Health Information Technology OON        An Out-of-Network (OON)  provider is one your insurance does not have a negotiated rate with.  In general: 1. Stay in-network if you can. Most payers (insurance plans) have the network accessible on their websites - find out your out-of-network benefits from your insurer (almost all plans have them). 2. If you get stuck with an out-of-network doctor, find out if you have coverage and if you don't, tell the doctor and they will usually work out some payment arrangement (anywhere from 30-70% off services), they will appreciate you doing this before the service than finding out from the insurer after the service. 3. If you have had the service and find out after the fact, call the doctor to arrange payment or look for TPA or cost containment group. They usually can assist in finding some resolution to the problem. 4. If your coverage does not have in-network providers within a certain geographical radius of your home, insurers are typically required to pay for services based on your standard in-network benefits. Also see “Deductibles”).   Open Access Scheduling        See Advanced Access Scheduling Orange Book        Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations.  The FDA provides a coding system, called the Orange Book , to help practitioners identify (for substitution purposes) a product's therapeutic equivalence, which is considered as such when it is pharmaceutically equivalent and meets the same safety and efficacy parameters.[2] Drug products that the FDA consider therapeutically equivalent receive an A rating (followed by a letter designating its dosage form) if it meets the said criteria. An AB rating denotes products that have sufficient evidence to resolve any bioequivalence problems and are therefore considered therapeutically equivalent. However, it is also important to keep in mind that generic products are only compared with their brand products and not with the same product made by other manufacturers. orphan drug        The FDA gives an orphan drug designation to drug candidates that treat a disease that affects less than 200,000 persons in the United States.  The designation is designed to give financial incentives to drug makers so that drugs for rare diseases will be developed. Out-of-Network Provider        Physicians who are not contracted with a managed care plan. Outpatient        A patient who receives health care services, but is not admitted to a hospital during a 24-hour period. outpatient facility        The term outpatient facility means “a facility (located in or apart from a hospital) for the diagnosis or diagnosis and treatment of ambulatory patients (including ambulatory inpatients):  (1) which is operated in connection with a hospital, or (2) in which patient care is under the professional supervision of persons licensed to practice medicine or surgery in the State, or, in the case of dental diagnosis or treatment, under the professional supervision of persons licensed to practice dentistry in the State; or (3) which offers to patients not requiring hospitalization the services of licensed physicians in various medical specialties, and which provides to its patients a reasonably full-range of diagnostic and treatment services.”  (Reference: Pursuant to 42 USCS § 291o [Title 42. The Public Health and Welfare; Chapter 6a. The Public Health Service Administration and Miscellaneous Provisions Administration]) OV        Office Visit, also Observation Verification PACE        Program of All-Inclusive Care for the Elderly -  These programs provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. Services include primary and specialty medical care, nursing, social services, therapies (occupational, physical, speech, recreation, etc.), pharmaceuticals, day health center services, home care, health- related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health. A PACE program is a Medicare Advantage program.  See CMS’ PACE fact sheet. PACS        Picture Archiving and Communication System  –  see DICOM standard PALS        Pediatric Advanced Life Support (PALS), A source of online education for physicians.  See American Medical Resource Institute (AMRI) Partialist        See Limited Care Practitioner (LCP) Pass-through billing        Pass-through billing occurs when the ordering provider requests and bills for a service, but the service is not performed by the ordering provider.  Ref1, PAT        Pre Admission Testing, testing for medical clearance before surgery PAT        Paroxysmal Atrial Tachycardia.  This is a broad term that covers any fast atrial rhythm that starts and stops suddenly.   Patient Panel        A patient panel is the group of patients that routinely seeing a provider.  A patient that has not seen a provider in 3 years is typically not counted as part of the panel.  As a rule of thumb, primary care providers working “full time” typically have appointment request from about 1% of their panel per day. Panel Size: How Many Patients Can One Doctor Manage? (from AAFP) Calculate your ideal patient load: How to strike the correct balance (from AMA) Rightsizer 1.0. is a tool for computing optimum panel size that considers factors such as the amount of time off doctors want and the amount of overtime they're willing to put in, how many patients they are able to see per day and other issues … Contact Dr. Savin via e-mail (svs30@columbia.edu) Patient portal        Patient Portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers, such as physicians and hospitals. Payment Card Surcharge        A payment card surcharge is a fee that a retailer adds to the cost of a purchase when a customer uses a payment card.  Rules for surcharges vary with State law.  In general:  Ref1, Ref2 1. Consumers will pay an additional fee when they use their credit card at retailers that decide to surcharge. 2. Consumers should be aware there are limits to the amount merchants can surcharge. 3. Retailers are permitted to apply a surcharge to only credit card purchases and cannot impose a surcharge for purchases made using a debit or prepaid card. 4. If retailers intend to impose a surcharge on credit card purchases, they are required to notify customers before customers make an actual purchase at the store entrance and at the point of sale – or in an online environment, on the first page that references credit card brands. 5. Retailers must disclose surcharge fees on every receipt – both in store and online. Carefully review receipts where checkout fees should appear. PBPM        Practice-based Population Management   Ref1, Ref2 PCIP        Medicare Primary Care Incentive Program  (See AAFP article) PCMH        Patient-Centered Medical Homes.   NCQH defines different levels of PCMHs (1st, 2nd, ...) Overview and Documents from Colorado Academy (lots of information) Many state reform initiatives are basing their definition of the PCMH on the Joint Principles of the Patient-Centered Medical Home The principles also adopted by the AMA Also see Patient Centered Primary Care Collaborative (PCPCC) No Direction Home: A Primary Care Physician Questions The Medical Home Model Video about PCMH objectives Relationship to Transformed PCMH huddle         PCMH-N        Patient-Centered Medical Home Neighbor -  The interface of the patient centered medical home with specialty/subspecialty practices.  Ref1 PCMN        Patient Centered Medical Neighborhood PCORI        Patient-Centered Outcomes Research Institute Ref1: “Medicine's 'Hard Drive' Is Crashing” and related article, Ref2: Lies, Damned Lies, and Medical Science PCP        Primary Care Physician PCPCC        Patient Centered Primary Care Collaborative - The Patient Centered Primary Care Collaborative is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, physicians and many others who have joined together to develop and advance the patient centered medical home. The Collaborative believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system. In order to accomplish our goal, employers, consumers, patients, physicians and payers have agreed that it is essential to support a better model of compensating physicians. PCPCH        Patient-Centered Primary Care Homes, - A program similar to NCQA/PCMH recognition used by Oregon’s Medicaid program. Ref1, Ref2 PCPI        Physician Consortium for Performance Improvement, An AMA organization with mission of: 1 - Identifying and developing evidence-based clinical performance measures and measurement resources that enhance quality of patient care and foster accountability 2 - Promoting the implementation of effective and relevant clinical performance improvement activities 3 - Advancing the science of clinical performance measurement and improvement PCPO        Physicians Care Plan Oversight PE        Pulmonary Embolism occurs when clots break off from vein walls and travel through the heart to the pulmonary arteries. The broader term venous thromboembolism (VTE) refers to DVT, PE, or to a combination of both. PECOS        Provider Enrollment, Chain and Ownership System (PECOS) supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the Internet.  This website allows registered users to securely and electronically manage Medicare enrollment information. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. CMS permits such physicians or other eligible professionals to enroll in the Medicare program for the sole purpose of ordering or referring items or services for Medicare beneficiaries. The submission and approval of a completed, CMS-855O form or its internet-based PECOS equivalent will register/enroll the physician or other eligible professional in the Medicare Program for the sole purpose of ordering and referring specific services for Medicare beneficiaries.  Reference: The Affordable Care Act, Section 6405 PFSH        Past, Family, Social History PFT        Pulmonary Function Test PGHD        Patient Generated Health Data, Ref1, Ref2, Ref3 PGY-1        Postgraduate Year One is first year of residency training for medical students matched by the National Resident Matching Program (NRMP) PHI        Protected Health Information - HIPAA requires that PHI be communicated on a Need to Know and Minimum Necessary basis to protect the patient’s health information. Instead of the entire chart being sent to another entity only requested information that is part of the treatment, payment, or for organizational administration should be given. Protected health information (PHI) is any information in the patient’s medical record or designated record set that can be used to identify an individual. This information may be used by the provider, but must be protected. This data includes 18 means of identification of a patient PHO        Physician Hospital Organization PHR        Personal Health Record - a health record where health data and information related to the care of a patient is maintained by the patient.[1] This stands in contrast with the more widely used EMR which is operated by institutions (such as a hospital) and contains data entered by clinicians or billing data to support insurance claims.  Also see  List of PHR products PHSA        Public Health Service Act physc        physician Physicians' Foundation        The mission of the Physicians' Foundation includes evaluating government legislation, educating physicians on leadership skills, assessing the supply of physicians, etc.  See report: “The Future of Medical Practice: Creating Options for Practicing Physicians” PHYTEL        Phytel provides health care organizations with population health technology. PMD        Preferred Medical Doctor PMD        Primary Medical Doctor PMFSH        Past Medical, Family and Social History –  A patient history typically includes: PFSH, HPI (History of Present Illness), and ROS (Review of Systems) PMH, PMHx        Past Medical History, In a medical encounter, a past medical history is the total sum of a patient's health status prior to the presenting problem. PMPM        Per Member Per Month  A cost calculated by deriving the average of total healthcare costs for a single member in a month.  PMPM is an indicator for healthcare expenditure and it is analyzed against different health status category parameters such as Healthy, Significant acute, etc.  See capitation payment. PMS        Practice Management System PNHP        Physicians for a National Health Program – An organization that lobbies for a single payer national healthcare system POA        Present on Admission – Medicare no longer pays for certain conditions that were not present on admission POA        Power of Attorney POL        Physician Office Laboratories POLST        Physician Orders for Life-Sustaining Treatment is an approach to improving end-of-life care by encouraging doctors to speak with patients and create specific medical orders to be honored by health care workers during a medical crisis.POLST began in Oregon in 1991 and is currently promoted in over 26 states through national and statewide initiatives. The POLST document is a standardized, portable, brightly colored single page form which documents a conversation between a doctor and a seriously ill patient or their surrogate decision-maker. As a medical order, the POLST form is always signed by a doctor and, depending upon the state, the patient. One benefit of a POLST form over a standard Advance Health Care Directive is that the POLST form is designed to be actionable throughout an entire community. It is immediately recognizable and can be used by doctors and first responders (including paramedics, fire departments, police, emergency rooms, hospitals and nursing homes). POLST forms should be filled out for all patients with life-limiting illnesses or progressive frailty. A pragmatic rule for initiating a POLST can be if the clinician would not be surprised if the patient were to die within one year.[ polyphamacy        The use of multiple drugs in a single prescription  Also,the use of multiple drugs to treat multiple concurrent disorders in the same patient; especially the indiscriminate prescription of many drugs to elderly patients POMR        Problem Oriented Medical Record - The key parts of the problem-oriented system are these: 1. Initial data collection appropriate to the patient to ensure that relevant problems are discovered. 2. A list of the problems identified. 3. Treatment plans for each problem.  Ideally these should clarify: a. The basis for classifying this as a problem (e.g., elevated BP readings for hypertension) b. The goal(s) for managing the problem c. Status of the problem (likely to change over time) d. Disability or significance of the problem in patient's life e. The parameters to be followed in assessing the problem f.  Complications to watch for g. Investigations (further evaluation), Instructions (patient education), and Interventions (treatment) to be done. 1.        Progress notes related to specific problems.  The style or format of the progress note is relatively unimportant.   But the content of the note should allow one to assess how well the practitioner is following the diagnostic plan (3g), defined parameters (3e) and evidence of complications (3f).  It should also identify response to therapy (3g) and changes to the status, goals, and therapy of the problem. Ref: See SOAP note and article “Medicine in Denial” by Dr. Lawrence Weed and Lincoln Weed Part 1  and  Part 2 POS        A POS (Point of Service) insurance plan is a hybrid of an HMO and a PPO health-care plan. Like an HMO (Health Maintenance Organization) plan, a network of contracted doctors is provided to the members, and they may elect to choose a primary-care physician. The PCP's role is to coordinate all aspects of the patient's health care. Similar to the other managed-health care plan, the PPO (Preferred Provider Organization) plan, gives you the flexibility to seek doctor care in and out of network and still receive most of their insurance benefits. POS        Place of Service POST        Physician’s Orders On Scope Of Treatment (See POLST).[ PPACA        Patient Protection and Affordable Care Act PPCP        Priority Primary Care Provider – generally includes family practice, obstetrics, gynecology, geriatrics and internal medicine PPD        The PPD skin test is a method used to diagnose tuberculosis (TB). PPD stands for purified protein derivative.   YouTube Educational Video, Ref1 PPD        Post-Partum Depression PPI        Proton Pump Inhibitor PQRI        Physician Quality Reporting Initiative – A Medicare incentive payment of 2.0 percent of total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during the 2009 calendar year. Overview, CMS Overview, Webinar.   First established as the Physician Quality Reporting Initiative (PQRI) for the reporting period of July 1 through Dec. 31, 2007, the program was renamed the Physician Quality and Reporting System (PQRS) in 2011. Physicians and nonphysician providers who participate in the program transmit data to the Centers for Medicare & Medicaid Services (CMS) regarding quality measures related to care provided to their Medicare patients. PQRS        Physician Quality Reporting System (PQRS) - The Physician Quality Reporting System (Physician Quality Reporting or PQRS) is a  reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. Resources: 1.http://www.aafp.org/online/en/home/practicemgt/quality/qitools/perfmeasure/demoproject/cmspqri.html 2. http://blogs.aafp.org/fpm/gettingpaid/entry/four_reasons_to_participate_in 3. http://blogs.aafp.org/fpm/gettingpaid/entry/ehr_incentives_and_pqrs_can 4. AAFP discount for members using the PQRIWizard registry. More information on that product is available at: 5. CMS step-by-step instructions on how to get started with PQRS 6. AQAF Webinar: “How To Avoid Medicare Penalties Through PQRS Reporting” (very good summary) PQTP        Physician Quality and Transparency Program: (www.bcbsal.com).  Special Bulletin 2008-21 explains reason for the Physician Quality and Transparency Program. Pre-Certification        Also known as pre-admission certification, is the process of obtaining authorization from the health care plan for routine inpatient and outpatient admissions. Failure to obtain pre-certification may result in penalty to the provider or the subscriber. Primary Care Physician        A physician, usually a general, family practitioner or internist, who delivers general health care, and is most often the first doctor a patient sees. This physician treats the patient directly, refers them to a specialist (or secondary care physician) or admits them to the hospital. PRN        PRN: Per Rising Need.   As the situation may require, more particularly directions on medical charts by doctors for the benefit of nursing staff indicating actions that may be taken at their discretion depending on patient condition. PRO        Patient-reported outcome - PRO is an umbrella term that covers a whole range of potential types of measurement but is used specifically to refer to questionnaires completed by the patient. PRO data may be collected via self-administered questionnaires completed by the patient themselves or via interviewer-administered questionnaires. Professional courtesy        Professional courtesy may apply when a physician treats another physician, his/ her own employees or their family members, or other healthcare providers. When professional courtesy is extended, the fee for the physician treating the patient is usually made at a reduced rate, or the copayment may be waived. Professional Organizations        AMA is the largest physician’s organization. The three largest subspecialty organizations include: ACP - American College of Physicians – Internal Medicine (130,000 members) AAFP – American Academy of Family Physicians (100,000 members) ACS - American College of Surgeons (70,000 members) Provider        A physician, hospital, laboratory, pharmacy or other organization that provides health care, goods or services. PSA        Prostate-specific antigen (PSA) - Most PSA in the blood is bound to serum proteins. A small amount is not protein bound and is called free PSA. In men with prostate cancer the ratio of free (unbound) PSA to total PSA is decreased. The risk of cancer increases if the free to total ratio is less than 25%. The lower the ratio the greater the probability of prostate cancer. Prostate-specific antigen is also known as kallikrein III, seminin, semenogelase, γ- seminoprotein and P-30 antigen. PSA        Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in the blood. PSH        Past Surgical History PT/INR Prothrombin        Time and International, also known as: Prothrombin Time; Pro Time; Protime.  Prothrombin time (PT) evaluates the ability of blood to clot properly, it can be used to help diagnose bleeding. When used in this instance, it is often used in conjunction with the PTT to evaluate the function of all coagulation factors. Occasionally, the test may be used to screen patients for any previously undetected bleeding problems prior to surgical procedures.  The International Normalized Ratio (INR) is used to monitor the effectiveness of blood thinning drugs such as warfarin (Coumadin). These anti-coagulant drugs help inhibit the formation of blood clots. PTS        Post-Thrombotic Syndrome, also see CDT and DVT, Ref 1 Pulse oximeter        A pulse oximeter is a device that indirectly measures the oxygen saturation of a patient'sblood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a photoplethysmograph. Most monitors also display the heart rate. q.i.d or qid or QID        four times a day; q.i.d. stands for "quater in die" (in Latin, 4 times a day). q_h        If a medicine is to be taken every so-many hours, it is written "q_h"; the "q" standing for "quaque" and the "h" indicating the number of hours. So, for example, "2 caps q4h" means "Take 2 capsules every 4 hours." qd        quaque die, a Latin phrase meaning "every day" QIO        Quality Improvement Organization QT Syndrome        The long QT syndrome (LQTS) is a rare inborn heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsade de pointes (TDP, a form of irregular heartbeat that originates from the ventricles). These episodes may lead to palpitations, fainting and sudden death due to ventricular fibrillation. Episodes may be provoked by various stimuli, depending on the subtype of the condition.  The condition is so named because of the appearances of the electrocardiogram (ECG/EKG), on which there is prolongation of the QT interval. In some individuals the QT prolongation occurs only after the administration of certain medications. Quality Collaborative Committee        The Quality Collaborative Committee was formed in response to our customers’ demands for greater transparency on physician and hospital quality measures and related information. The group consists of leaders from the physician community, hospitals, business, and Blue Cross and Blue Shield of Alabama. r/o        Rule Out RA        Rheumatoid Arthritis RAA        Renin-Angiotensin-Aldosterone (RAA) RAC        Recovery Audit Contractors – Contractors which seeks to recover Medicare overpayments to physicians and other providers. The AAFP has compiled an online guide to help physicians better understand and cope with the program. RAF        Medicare Advantage was created in 1997, and in 2007 the risk adjustment phase in was completed for the participating Medicare Managed Care Organizations ("MCO's.") The risk adjusted reimbursement model is based on chronic and cumulative conditions called "hierarchical condition categories ("HCC's.") The historic model for physician reimbursement has been fee-for-service. Doctors get paid for the services they provide to their patients. The CPT codes and their individual relative values essentially drive reimbursement and the ICD-9 diagnostic codes support the medical necessity of those services under this structure. The Medicare Advantage HCC model turns this upside down. With 100% risk adjustment, the ICD-9 diagnostic codes do more than support medical necessity; they now drive CMS's payments to MCO's for their Medicare Advantage members. There are more than 3,000 ICD-9 codes that can adjust risk, but only 70 HCC groups.  Diagnoses are classified into groups to include clinically related conditions with similar cost-of-care ramifications. About 80% of the diagnoses used in the Risk Adjustment Processing System ("RAPS") originate from the physicians' claim forms. The RAPS creates a Risk Adjustment Factor ("RAF") that identifies the individual patient's status. All of this is highly influenced by the historic costs of caring for specific chronic diseases, and payments are based upon the most severe disease manifestation. Comorbidities can have a significant impact on the RAF and HCC determination, and consequently the MCO's reimbursement. MCO's can look backward in the medical records to correct incomplete coding. This involves reviewing the patients' medical records to look for documentation that supports any of those 3,000+ previously unreported diagnoses (unreported because they may not have been the medical necessity for a reported service.) RAF        Risk Adjustment Factor (RAF) coding applies to Medicare Advantage patients.  These are capitated Medicare plans that pay providers a certain amount of money per patient per year rather than paying per patient encounter.  The RAF is determined by several factors (age, sex, disabled or not, Medicaid or not, and diagnoses/morbidities).  Adding up all of the risk scores gives a number which is then multiplied by some standard factor to yield the amount paid for that patient for the year.  This is paid by Medicare to the insurance plan but is then typically passed on to the clinicians based on the total RAF of their patient panel with than plan.   Hierarchical Condition Categories (HCC) specify a subset of ICD-9 codes that add up morbidities to contribute to the RAF score above.  Each category a patient qualifies for (by having at least one ICD-9 code in that category) adds a specified amount to their RAF score.  The more categories a given patient has a code for, the more they can increase their RAF score.  A capitated patient with AIDS, a stroke, multiple sclerosis, diabetes with retinopathy, an amputation, etc. pays a lot more per year than a patient without any HCC-qualifying ICD-9 codes who basically just earns a RAF score based on age/sex/demographics alone.   The "hierarchical" term means that categories are grouped and ranked so you might get 1 point for controlled diabetes or 5 points for diabetes with retinopathy but if you get the 5 for DM with retinopathy that disqualifies you from also getting the 1 point for controlled diabetes.  In other words, you can qualify for the best HCC category in a group but not more than 1 category in a group.   There are also some increased RAF scores for disease interactions in that you get more RAF score for a patient who has BOTH diabetes and CHF than you would just by scoring them for Diabetes and CHF (there's extra points for having both together).  Same for CHF + COPD and several others.   From a coder's perspective, RAF/HCC coding makes it very worthwhile to scan charts to pick up and submit HCC- qualifying ICD-9 codes that might have been addressed at a visit but not previously submitted for a patient.  Catching an extra diagnosis or two could end up getting the practice paid 2-3 times as much for that patient's care for the year.   In the normal coding world, reimbursement is determined by the CPT code and the ICD-9 code just supports the CPT code.  In HCC/RAF world, CPT code is irrelevant and the ICD-9 codes submitted over the course of the year with encounters or outside of encounters based on chart review determine the patients annual RAF and the reimbursement for the patient for the year.  (Reference 1) RAPS        Risk Adjustment Processing System (RAPS) RBBB        Right Bundle Branch Block - a defect in the heart's electrical conduction system. See ETT RBRVS        Resource-Based Relative Value Scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is currently used by Medicare in the United States and by nearly all Health maintenance organizations (HMOs). Ref A, RefB, RefC, RefD.  RBRVS pays physicians based on the estimated “inputs” to provide a medical service, such as the time, energy and effort required to provide a medical service.  (See RVS) RCB        Recognized certifying body RD        Registered Dietician REC        Regional Extension Center Referral Authorization        Approval for a member to see a physician or access services outside of the participating medical group. Referring Physician        A physician who sends a patient to another doctor for specialty care or services. relative        AMA Ethical policy E-8.19 states that physicians generally should not treat themselves or members of their immediate families. The policy explains the rationale. It notes that there are some situations in which routine care is acceptable for short-term, minor problems. It also states that except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members. Medicare bars payment for items and services rendered by physicians to immediate relatives of the physician, to the physician’s partner in a partnership or to members of their household. The exclusion also includes services provided incident to. “Immediate relatives” is defined to include husband and wife; natural or adoptive parent, child and sibling; stepparent, stepchild, stepbrother, and stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in- law, and sister-in-law; grandparent and grandchild; and spouse of grandparent and grandchild. Federal law in the area of prescription writing is limited to controlled substances. These laws require that the prescriber have a bona fide patient-physician relationship. .A few states go a step further and address prescription writing of all drug classes. REMS        Risk Evaluation and Mitigation Strategies (REMS) - The Food and Drug Administration Amendments Act of 2007 gave FDA the authority to require a Risk Evaluation and Mitigation Strategy (REMS) from manufacturers to ensure that the benefits of a drug or biological product outweigh its risks. REST        Representational state transfer RFA        Regulatory Flexibility Act RHC        Rural Health Clinic (RHC) - There are more than 3,600 Rural Health Clinics (RHCs) in the USA.  In 1977, the U.S. Congress created the RHC program, which reimburses Medicare and Medicaid at higher “allowable cost” rates than most clinics and hospitals. To qualify as an RHC, a clinic must assist a non-urban and medically underserved population, in an area with a shortage of health professionals. RHCs must also employ a PA or NP.   The U.S. Health Center Consolidation Act of 1996 further created the Federally Qualified Health Center (FQHC) reimbursement designation, covering more than 1,120 clinics that help medically underserved communities, including migrant health centers and health care clinics for the homeless. FQHCs are not required to employ PAs and NPs, though many do. They tend to be located in urban areas, but may operate anywhere.1 Unlike RHCs, FQHCs must be nonprofit or publicly-owned. RHIO        Regional Health Information Organizations,  Also see HIO RHIT        Registered Health Information Technician -  The role of an RHIT is to manage and analyze health care data and generate statistics. This work is used to evaluate the quality of various health care programs, check compliance with standards, and evaluate costs. Risk-Stratified Care Management        The Comprehensive Primary Care Initiative (CPCI) includes five parts   Risk-stratified care management   Access and continuity   Planned care for chronic care & preventive care   Patient & caregiver engagement   Coordination of care across the medical neighborhood River's protocol        A protocol used by Rivers and colleagues in an early goal-directed therapy study.  Compared with other populations of septic patients, the patients of Rivers and colleagues had a higher incidence of severe comorbidities, a more severe hemodynamic status on admission (excessively low central venous oxygen saturation [ScvO2], low central venous pressure [CVP], and high lactate), and higher mortality rates. Reference ROI        Release of Information ROI        Return on Investment ROM        Range of Motion ROR        Reach Out and Read (ROR), is an American non-profit organization that advocates for childhood literacy. and give them the tools (the books) to do so. ROR makes literacy promotion a standard part of pediatric primary care, building upon the relationship between parents and health care providers. ROS        Review Of Systems RPR        Rapid Plasma Reagin, a modern screening test for antibodies in the serum of patients with syphilis RSV        Respiratory Syncytial Virus is a respiratory virus that infects the lungs and breathing passages. Most otherwise healthy people recover from RSV infection in 1 to 2 weeks. However, infection can be severe in some people, such as certain infants, young children, and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia in children under 1 year of age in the United States. RUC        The full name of the RUC is Specialty Society Relative Value Scale Update Committee,  a group of doctors that advises the Centers for Medicare and Medicaid Services (CMS) on reimbursement rates for medical procedures. Ref1 RVS        When the government created the Medicare system in 1965, they were so desperate to get doctors into it that they allowed them set their own fees. The fee for service system was good for doctors, but bad for the budget. Joseph Califano, was President Johnson's senior domestic policy aide at the time, and he says he and his colleagues simply didn't understand the economic structure of the health care system. Ten years later, President Ford thought he had the solution to stem rising costs -- cap the fees paid to doctors. Unfortunately this "fix," just caused another problem, overtreatment. It wasn't until the late 1980's that an economist from Harvard, Professor William Hsiao, finally came up with method to determine competitive prices for doctor's care. Hsiao brought in doctors and asked them to rate every single thing they did based on how technically hard it was, how stressful, how much the supplies cost, etc. From this data, he developed the relative value scale. Medicare adopted the relative value scale in 1992, and it's still used today. However, the system has done little to cut rising costs -- something Hsiao blames on special interest groups. RVU        Relative Value Units (factor used in pricing of medical services), the numeric reimbursement value associated with the services your practice provides. (See RBRVS). More at Wikipedia.  CMS website has a Physician Fee Schedule Search that allows RVUs to be looked up for a single code, a list of codes, or a range of codes.  You can get RVU info for past/current years, as well as payment indicators for global days and modifier use. CMS website - payment under the physician fee schedule RxNorm        A standard for ? ? EMR data standard RXNs        Reactions SAM        Self-Assessment Module, Part of ABFM Part 2 Self-Assessment and Lifelong Learning Sanction Screening        Sanction Screening - As a condition of participation in government programs, healthcare providers must screen against published sanction data all those with whom they engage or have a business relationship. CMS regulations state that “No payment will be made by Medicare, Medicaid, or any of the other federal health care programs for any items or service furnished by an excluded individual or entity.  Ref1, Ref2, Ref3, SCHIP        State Children's Health Insurance Program.  SCHIP Is A Joint Federal And State Program That Currently Provides Coverage To More Than 6 Million Uninsured Children From Working Families Who Are Not Poor Enough To Qualify For Medicaid.  See CMS Web Site scribe        "Scribe" situations are those in which the physician utilizes the services of his, or her, staff to document work performed by that physician, in either an office or a facility setting. In Evaluation and Management (E/M) services, surgical, and other such encounters, the "scribe" does not act independently, but simply documents the physician's dictation and/or activities during the visit. The physician who receives the payment for the services is expected to be the person delivering the services and creating the record, which is simply "scribed" by another person. Guidelines for the Use of Scribes in Medical Record Documentation SCRIPT        SCRIPT is a standard promulgated by the National Council for Prescription Drug Programs (NCPDP) for the electronically transmitted medical prescriptions in the United States.  The first version of SCRIPT was approved in 1997. Version 8.1 was proposed as a federal rule by the Centers for Medicare and Medicaid Services ("CMS") in November, 2007, and adopted in 2008, thereby mandating its use for medical providers that used electronic subscriptions, in order to obtain federal insurance reimbursement.[1] A new "backwards-compatible" version, 10.1, was adopted by the Surescripts pharmacy consortium in late 2009 to help its members participate in the electronic medical record incentive programs under the HITECH Act. It was proposed by CMS as a rule in June, 2010.  See NCPDP SDM        Shared Decision Making is an approach where clinicians and patients communicate together using the best available evidence when faced with the task of making decisions, where patients are supported to deliberate about the possible attributes and consequences of options, to arrive at informed preferences in making a determination about the best action and which respects patient autonomy, where this is desired, ethical and legal. SDOH        Social Determinants Of Health - the conditions in which people are born, grow, live, work and age, including the health system. SGR        Sustainable Growth Rate - Medicare physician payment is annually updated on the basis of the SGR formula, which ties annual physician payment increases to the performance of the general economy. SH        Social History SHIM        Sexual Human Inventory for Males (SHIM) screening questionnaire SHIP        State Health Insurance Assistance Program SHIP        Student Health Insurance Plan SI        Severity of illness Signature log        A signature log is a sheet of paper or a notebook with the printed name and written signature of everyone in the practice who signs records for any reason.  It should include nurses, staff, physicians, etc. SIMPD        Society for Innovative Medical Practice Design, a nonprofit organization, was founded in 2003 for the purpose of furthering the needs of physicians interested in innovative medical practices SLUMS        Saint Louis University Mental Status Examination SNF        Skilled Nursing Facilities – In general, an establishment that houses chronically ill, usually elderly patients, and provides long-term nursing care, rehabilitation, and other services. Also called long-term care facility, nursing home. An institution or part of an institution that meets criteria for accreditation established by the sections of the Social Security Act that determine the basis for Medicaid and Medicare reimbursement for skilled nursing care. Skilled nursing care includes rehabilitation and various medical and nursing procedures. Written policies and protocols are formulated with appropriate professional consultation. Law requires that these policies designate which level of caregiver is responsible for implementation of each policy, that the care of every patient be under the supervision of a physician, that a physician be available on an emergency basis, that records of the condition and care of every patient be maintained, that nursing service be available 24 hours a day, and that at least one full-time registered nurse be employed. Other criteria stipulate that the facility have appropriate facilities for storing and dispensing drugs and biologics, that it maintain a use review plan, that all licensing requirements of the state in which it is located be met, and that an overall budget be maintained. SNMHI        Safety Net Medical Home Initiative SNOMED CT        Systematized Nomenclature of Medicine -- Clinical Terms, is a systematically organized computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, pharmaceuticals etc. It allows a consistent way to index, store, retrieve, and aggregate clinical data across specialties and sites of care. It also helps organizing the content of medical records, reducing the variability in the way data is captured, encoded and used for clinical care of patients and research. SNOMED CT is one of a suite of designated data standards for use in U.S. Federal Government systems for the electronic exchange of clinical health information.  SNOMED CT consists of over a million medical Concepts. SOAMP        Adding an “M” for medical decision creates a SOAMP note. The addition of this section prompts to document discussions with other professionals, additional history obtained from family, and lab, radiology or other reports reviewed during the visit. Improved documentation of data review sometimes enables coding a higher level visit, and this format makes all the elements required by the Documentation Guidelines for Evaluation and Management Services readily evident for any reviewer or auditor: history (Subjective), physical exam (Objective), diagnoses (Assessment), data review (Medical decision making), and treatment (Plan). - Terry L. Mills Jr., MD SOAP        Subjective, Objective, Assessment, Plan (SOAP), one of three major chart formats.  Typically the “s” part includes: HPI, PMH, ROS, FH, SH.   Others chart formats include HPIP and HEAP. Opinion 1:  In my opinion the SOAP note is nothing but soapy. Certainly NOT VALID in concept -- and arrogant to boot. I thought so the day I heard about it as some great improvement, and realized it was dead wrong. Marketing, nothing less. Consider this: S = subjective (what the patient says), "I had an appendectomy in 1958." That's NOT subjective.   That's objective data. And O = objective? The doctor writes" there is a soft systolic heart murmur" Oh right! Maybe, maybe not. It's his SUBJECTIVE opinion.  In other words: whatever the patient says is subjective? (and not quite believable) whatever the doctor says is objective? (an absolute fact). I don't think so. (That's the arrogant part). Even the term "Assessment" is flawed at the stage of first encounter.  How can you assess with the first H & P? You can't – it’s only impression.  Only later comes the assessment.  I prefer HPIP (HISTORY; PHYSICAL; IMPRESSION: PLAN). Opinion 2: Whether "subjective, objective, assessment, and plan" or "history, physical, impression, and plan", they are referring to the same things. SOAP just makes for a better acronym. The value of Weed's Problem Oriented Medical Records approach was that it gave a logical structure to clinical documentation; SOAP and HPIP are functionally identical. Prior to Weed, most medical documentation was chaotically organized. Opinion 3: I prefer:  History, Physical, Impression, Plan. Until you have a firm Dx it's just an Impression, not even really a true Assessment.  Since when is the doctor so "objective"?   I know many patients who are more objective than some doctors I know. Opinion 4: See SOAMP SOAP        Simple Object Access Protocol SOAPP        Subjective, Objective, Assessment, Plan, Prevention Spirometer        A measuring instrument for measuring the vital capacity of the lungs Squamous Cell Carcinoma        Squamous Cell Carcinoma (SCC) is the second most common malignant lesion of the skin, also resulting from long term sun exposure and damage. SCCs present as pink, rough, scaly patches, similar in appearance to Actinic Keratosis. Some SCCs will present as a bump with ulceration and bleeding (which is not seen in AK). SCC lesions may be confined to the superficial layer of the skin (carcinoma in situ, or Bowen’s disease) or can penetrate the deeper skin layers (invasive SCC). If left untreated, SCC can spread to other organs (metastatic SCC). Diagnosis and Treatment – The diagnosis of SCC is established by skin biopsy. Treatment of localized disease includes excision, cryosurgery, or radiation therapy. Treatment of metastatic disease consists of either surgical resection, chemotherapy, radiation therapy, or a combination of these therapies SRI        Serotonin Reuptake Inhibitors SSRI        Selective serotonin reuptake inhibitor - A class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders.  Ref1 Subscriber        A person who enrolls in a health care plan and agrees to pay for premiums, co-payments and deductibles that are part of the plan. Sunshine Act        A health care reform law requiring drug and device manufacturers and group purchasing organizations (GPOs) to report payments or gifts of $10 or more made to physicians, hospitals and other providers on a yearly basis.  The provision, known as the Physician Payments Sunshine Act, also requires manufacturers of these products and GPOs to report ownership and investment interests held by physicians or their immediate family members in the entities. Ref1, Ref2 Surescripts        Surescripts is  the network through which eRx is conducted; it connects eRx systems to pharmacies. As such, it mandates a set of protocols and standards (e.g., new Rx, Rx refill request) that eRx system vendors must implement (and be certified to have properly implemented) in order to be connected to the network. While Surescripts requires that eRx system vendors implement certain functionality, it does not produce eRx system software itself. It is not possible to do eRx in America without using Surescripts. It is the only eRx network in America, so all real (i.e., not just faxing) eRx systems must use Surescripts. t.i.d. (or tid or TID)        Is three times a day ; t.i.d. stands for "ter in die" (in Latin, 3 times a day). A prescription should indicate route, frequency and relationship to food, and duration of treatment. TID PR TID PO AC QD TID SC TANCS        Technologies/Amenities and Noncovered Services.  A type of retainer fee.  See NCBF, FFNCS TCBI        The Center for Business Innovation Tdap        See DTaP TEPR        An annual conference on electronic health record systems Thrombosis        Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss. Alternatively, even when a blood vessel is not injured, blood clots may form in the body if the proper conditions present themselves. If the clotting is too severe and the clot breaks free, the traveling clot is now known as an embolus.[ TIPAAA         The IPA Association of America titer        1. The concentration of a substance in solution or the strength of such a substance determined by titration. 2. The minimum volume needed to cause a particular result in titration.  3. The dilution of a serum containing a specific antibody at which the solution retains the minimum level of activity needed to neutralize or precipitate an antigen. Title VII        A federal program that provides funding for training primary care physicians.  Ref1, Ref2 TKA        Total Knee Arthroplasty tm        telemedicine TMED        The TransforMED Medical Home Model ToC        Transitions of Care TOS        Type of Service tPA        Tissue plasminogen activator (abbreviated tPA or PLAT) is a protein involved in the breakdown of blood clots. TPA        Third-Party Administrators TPO        TPO - Treatment, Payment and healthcare Operations TPO        Treatment, Payment, and Operations. Treatment is the provision, coordination or management of the patient by one or more providers. Payment includes activities involved in reimbursement of health care (billing, collections, claims management, verification of benefits, and review of health services with respect to medical necessity coverage. Health Care Operations of a covered entity include conducting quality assessment and improvement activities such as arranging for medical or legal review, along with general business management. TransforMed        Also see MHIQ, TMED Treating Physician        A physician who provides care to the patient while in the hospital, and usually works at the hospital or comes in as a specialist. tx        treatment UA, U/A        Urinalysis - Urinalysis, used to test for kidney failure, dehydration, diabetes, undernourishment, or bladder or kidney infection.  In general, a urinalysis (or "UA") is an array of tests performed on urine and one of the most common methods of medical diagnosis. A part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as color changes. The numbers and types of cells and/or material such as urinary casts can yield a great detail of information and may suggest a specific diagnosis. UC        Urgent Care UCUM        Unified Code for Units of Measure UDS        Urine Drug Screens UDT        Urine Drug Test UMLS        Unified Medical Language System Unassigned claim        An unassigned claim is one that is paid to the patient rather than being assigned to the medical provider.  If you are a Medicare participating physician, and you can have payment assignment to you (i.e., payment goes directly to you) or unassigned (goes to patient). Under the Privacy Act of 1974, you have no right to any information on the claim if it is unassigned. If you accept assignment, then they should discuss the disposition of the claim with you, absent any state law to the contrary. unbundling        See Fragmented billing UPD        Universal Provider Datasource – See CAQH UPIN        A provider identification number.  No longer used, now replaced by NPI UpToDate        UpToDate - A nice reference site but information with information presented in article formats.  Also provides CME.  See DynaMed URAC        URAC, formerly known as the Utilization Review Accreditation Commission, is a nonprofit organization promoting healthcare quality by accrediting healthcare organizations.  URAC's mission is to promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education. URI        Upper Respiratory Infection US        Ultra Sound USPSTF        United States Preventive Services Task Force - An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. USPSTF A and B Recommendations,   USPSTF calculator UTI        Urinary Track Infection Vaccine        See: Vaccination Information for Healthcare Professionals VAERS        A national postmarketing spontaneous reporting system for vaccine adverse events following receipt of US- licensed vaccines (See article) VAP        Vertical Auto Profile,  measures 15 separate components:  http://www.thevaptest. com/HealthcareProfessionals/ varicella        An acute contagious disease caused by herpes varicella zoster virus; causes a rash of vesicles on the face and body VNA        Visiting Nurses Association VNAA        Visiting Nurses Association of America VOV        Virtual Office Visits VTE        Venous Thromboembolism Embolism, Also see DVT and PE WMV        Welcome to Medicare Visit, also see IPPE  (Ref1, Ref2) Wood’s Lamp        An illuminating device with a nickel oxide filter that holds back all light except for a few violet rays of the visible spectrum and ultraviolet wavelengths of about 365 nm. It is used extensively to help diagnose fungus infections of the scalp and erythrasma. The light causes hairs infected with a fungus such as Tinea capitis to become brilliantly fluorescent.Ref 1, Named after: Robert W. Wood, American physicist, 1868-1955 WRRVW        Work Related Relative Value Units.  Large practices often base their compensation on WRVU.   There is a formula available from CMS. XML        eXtensible Markup Language Zoonoses        Zoonoses are diseases transmitted between humans and animals.  Zoonoses can be transmitted to humans from wild animals and pets, like in the case of Rabies.  When these diseases are transmitted to humans by mosquitoes or ticks they are called "arboviruses", a special category of zoonoses.  Examples of zoonoses transmitted by mosquitoes are West Nile Virus, Saint Louis, and Eastern Equine Encephalitis (EEE) viruses, while Rocky Mountain spotted fever, and Lyme disease are transmitted by ticks. Zung Depression Scale        The Zung Self-Rating Depression Scale is a depression measure designed by William WK Zung to assess the level of depression for patients diagnosed with depressive disorder.  The Zung Self-Rating Depression Scale is a short self administered survey to quantify the depressed status of a patient. There are 20 items on the scale that rate the four common characteristics of depression: the pervasive effect, the physiological equivalents, other disturbances, and psychomotor activities.  Also see GAD-7    Tell me about concierge physicians in Huntsville, Alabama.