Terms & Abbreviations

Here are a few terms & abbreviations that Medicare routinely uses; we have also included a few acronyms that might help guide you when you are trying to weave yourself through the Medicare website.

ABN

Advance Beneficiary Notice—(Used on Medicare claims to indicate financial liability)

BP

Medicare Provider Benefits Manual, Pub 100-02

Carrier

Medicare Part B payer

CHC

Certified in Healthcare Compliance

CHP

Certified HIPAA Professional

Clinician

Refers only to a physician, non-physician practitioner (NPP), occupational/physical therapist or speech and language pathologist

CP

Medicare Claims Processing Manual, Pub 100-04

Contractor

(Medicare) a Part A or B Payer but also other parties/entities utilized by Medicare to audit, investigate, administer specific Medicare programs, payers or providers/suppliers

CORF

Comprehensive Outpatient Rehabilitation Facility

CR

Change Request: Medicare’s Communication Tool with Contractors; it has a four digit number following the alpha characters e.g. CR 5478

FI

Fiscal Intermediary (Medicare Part A Payer)

HHA

Home Health Agency

HHS

Health & Human Services

LCD

Local Coverage Determination: A document produced by the local contractor detailing medically necessary services, documentation requirements and other provider/supplier guidances

MA

Medicare Advantage: Medicare Part C Managed Care Payer

MAC

Medicare Administrative Contractor

MSP

Medicare as the Secondary Payer

MPFS

Medicare Physician Fee Schedule

MSW

Medical Social Worker

NCD

National Coverage Decision: A document that relates the decision made by CMS relating to national policy for medically necessary services and other provider, payer and supplier guidances

NEMB

Notice of Exclusion from Medicare Benefits: a notice provided to a beneficiary regarding a non-covered item/service

NPI

National Provider Identifier

NPP

Non-Physician Practitioner: Refers only to physician assistants, clinical nurse specialists and nurse practitioners under routine Medicare policy; however for the purpose of Enrollment matters the term NPP also includes therapists

OPT

Outpatient Physical Therapy Provider (Rehab Agency-PT Services) this is not the Private Practice Practitioner or Group

ORF

Other Rehabilitation Facility (Rehab Agency- more than PT Services)

OTPP

Occupational Therapist in Private Practice

PECOS

Provider Enrollment, Chain and Ownership System (E-Enrollment)

Physician

Medical doctor, doctors of: osteopathy, podiatric medicine and optometry (low vision services only). Chiropractors and Dentists are excluded from the definition for the purpose of Plan of Care certifications/re-certifications and/or referrals to therapy providers/suppliers

PI

Medicare Program Integrity Manual, Pub 100—08

Provider

Institutions or facilities filing under Medicare Part A

PTPP

Physical Therapist in Private Practice

PTAN

Provider Transaction Access Number

Qualified Personnel

Qualified Personnel: Meets requirements of a graduate of an accredited therapy program; however, does not include licensure

Qualified Profess

Qualified Professional: OT, PT, SLP, physician/NPP licensed by the state and OTA/PTA when licensed by the state and when working under the supervision of an OT/PT

RAC

Recovery Audit Contractor

SLPPP

Speech & Language Pathologist in Private Practice

SNF

Skilled Nursing Facility

Supplier

Groups, individuals or others filing under Medicare Part B

Transmittals and Change Request Communications: Abbreviations

CMS’ notice of the need to change information in the appropriate CMS Manual (s) e.g. Transmittal-R63BP

R

Prescript on a Transmittal that has been revised

N

Prescript on a Transmittal that is new

D

Prescript on a Transmittal that has been deleted

BP

Postscript on a Transmittal indicating that the information is located in the BP Manual

CP

Postscript on a Transmittal indicating that the information is located in the CP Manual

PI

Postscript on a Transmittal indicating that the information is located in the PI Manual

CR

Change Request (it has a four digit number following the alpha characters e.g. CR 5478 it is associated with a Transmittal Document; both are used to relate CMS policy manual changes