There are many revenue cycle management acronyms and it can be challenging to remember all of them if you’re new in the medical billing field. For starters, here are the most important acronyms every healthcare provider should know:
AHIMA or American Health Information Management Association – The AHIMA medical abbreviation is a professional association for health information management (HIM) professionals. AHIMA provides education, resources, and advocacy for its members who work in areas such as medical coding, health information technology, data analytics, and privacy and security of health information.
AOB or Assignment of Benefits – The AOB medical abbreviation is a document signed by a patient that authorizes the healthcare provider to receive payment directly from the insurance company. It allows the provider to bill the insurance company directly instead of waiting for reimbursement from the patient.
BDR or Billing Data Report – The BDR medical abbreviation is a report that provides an overview of billing and reimbursement activities, including claim submissions, denials, and payments. BDRs help healthcare organizations analyze their financial performance and identify areas for improvement.
CARC or Claim Adjustment Reason Code – This is a code that provides information about why a claim was adjusted or denied by an insurance company. CARCs help identify the specific reason for claim denials or adjustments, allowing providers to take appropriate action.
COB or Coordination of Benefits – The COB medical abbreviation is the process of determining which insurance plan is primary and secondary when a patient has multiple coverage.
CMS or Centers for Medicare and Medicaid Services – This is a federal agency that administers the Medicare program and works in partnership with states to administer Medicaid.
CPT or Current Procedural Terminology – The medical abbreviation for CPT represents a set of medical codes healthcare professionals use to describe all the medical, surgical, and diagnostic services they provide.
CVO or Credentialing Verification Organization – The CVO medical abbreviation is an entity that verifies the credentials of healthcare providers, such as their education, licensure, and experience. This is used by insurance companies and healthcare organizations to ensure that providers are qualified to offer services.
EHR or Electronic Health Record – This is a digital version of a patient’s medical history, including diagnoses, treatments, medications, and test results. EHRs improve accessibility, accuracy, and efficiency in medical documentation and facilitate communication between healthcare providers.
E/M or Evaluation and Management – This is used to bill for physician services based on the complexity of patient encounters.
EOB or Explanation of Benefits – This is a document that insurance companies send, which includes a breakdown of the payment or denial of a claim.
HCC or Hierarchical Condition Category – This is a classification system used in risk adjustment to predict future healthcare costs based on the severity of a patient’s conditions. HCC coding helps insurance companies assess the expected cost of providing care to a specific patient population.
HCPCS or Healthcare Common Procedure Coding System – This is a coding system used to identify medical procedures and services not covered by CPT codes, such as durable medical equipment, prosthetics, and orthotics, among others.
HIPAA or Health Insurance Portability and Accountability Act – This is a federal law that protects the privacy and security of patient health information
ICD or International Classification of Diseases – This is a system used to classify and code diagnoses, symptoms, and procedures for the purpose of medical records and billing.
NPI or National Provider Identifier – This is a unique 10-digit identification number assigned to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). This ID allows healthcare providers to send information electronically much faster and easier.
PHI or Protected Health Information – Any individually identifiable health information that is protected under HIPAA (Health Insurance Portability and Accountability Act). PHI includes patient names, addresses, social security numbers, medical records, and other personal health data.
POS or Place of Service – This is a code that indicates where a healthcare service was provided, such as a hospital, clinic, or physician’s office.
PPO or Preferred Provider Organization – A type of health insurance plan that allows patients to choose from a network of preferred providers at a reduced cost.
RARC or Remittance Advice Remark Code – This is a code that provides additional explanation or clarification regarding a claim adjustment or denial. RARCs provide detailed information about claim processing issues, helping providers understand why a claim was denied or adjusted.