Glossary of Acronyms for the APN/PA WBT

Acronym Full Spelling and Definition of Acronyms
AANP American Academy of Nurse Practitioners
A professional membership organization in the United States for Nurse Practitioners of all specialties.
A/B MAC Medicare Administrative Contractor
A Medicare Administrative Contractor (MAC) is the new contracting entity, created to comply with Section 911 of the Medicare Modernization Act of 2003. MACs replace carriers and fiscal intermediaries and are responsible for the receipt, processing and payment of Medicare Fee-for-Service claims. In addition to providing core claims processing operations for both Part A and Part B, the MAC will be the primary contact for physicians and perform functions related to: Appeals, Provider Outreach and Education, Financial Management, Provider Enrollment, Reimbursement, Payment Safeguards, and Information Systems Security.
ACNM American College of Nurse-Midwives
A women’s health organization, with the mission to promote the health and well-being of women and infants within their families and communities through the development and support of the profession of midwifery as practiced by certified nurse-midwives, and certified midwives. ACNM provides research, administers and promotes continuing education programs, establishes clinical practice standards, and creates liaisons with state and federal agencies and members of Congress.
AMA American Medical Association
A professional organization for physicians. The AMA is the secretariat of the National Uniform Claim Committee (NUCC), which has a formal consultative role under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The AMA also maintains the Current Procedural Terminology (CPT) medical code set. The AMA has the copyright for the CPT, which is also a registered trademark of the AMA.
APN Advanced Practice Nurses

APNs are also known as Advanced Practice Registered Nurses (APRNs), are Registered Nurses with advanced education, knowledge, skills, and scope of practice. Most APNs possess a master's or doctoral degree in nursing and may also sit for additional certification examinations.

APNs may function as a Certified Nurse-Midwife (CNM), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS) or Certified Registered Nurse Anesthetist (CRNA). They perform primary health care, provide mental health services, diagnose, prescribe, carry out nursing research, and educate the public and other professionals. Some APNs diagnose illness and prescribe medication. Nurse Practitioners also specialize mainly in mid level primary care services at this time.

All advanced practice credentials have requirements such as continuing education and periodic re-examination to maintain the credential.

APNs can expect to earn above-average salaries, especially as the population ages and the demand for highly skilled mid level healthcare workers grows proportionally.
ASC Ambulatory Surgical Center
An accredited, freestanding facility that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization.
AWP Average Wholesale Price
The average price at which pharmaceutical wholesalers sell drugs to physicians, pharmacies, and other customers.
BBA Balanced Budget Act
1997 law that amended Sections of the Social Security Act to include anti-fraud and abuse provisions, program integrity, and certain preventive care benefits. Also established the State Children’s Health Insurance Program and Medicare Advantage.
CAAHEP Commission on Accreditation of Allied Health Education Programs
National programmatic accreditor in the health sciences field; reviews and accredits educational programs in nineteen (19) health science occupations: Anesthesiologist Assistant, Blood Banking, Cardiovascular Technology, Cytotechnology, Diagnostic Medical Sonography, Electroneurodiagnostic Technology, Emergency Medical Services Professional, Exercise Physiology, Exercise Science, Kinesiotherapy, Medical Assistant, Medical Illustrator, Orthotics and Prosthetics, Perfusion, Personal Fitness Trainer, Polysomnography, Respiratory Care, Surgical Assistant, and Surgical Technology.
CAH Critical Access Hospital

A Critical Access Hospital (CAH) is a hospital that is certified to receive cost-based reimbursement from Medicare. CAHs are certified under a different set of Medicare Conditions of Participation (CoP) that are more flexible than the acute care hospital CoPs.

A hospital is designated as a CAH by the State in which it is located and meets the following criteria:

  • Is a rural public, non-profit or for-profit hospital; or is a hospital that was closed within the previous ten years; or is a rural health clinic that was downsized from a hospital;
  • Is a facility located in a State that has established a State plan with CMS for the Medicare Rural Hospital Flexibility Program;
  • Is located more than a 35-mile drive from any other hospital or CAH (in mountainous terrain or in areas with only secondary roads available, the mileage criterion is 15 miles); or is certified by the State in the State plan as being a necessary provider of healthcare services to residents in the area;
  • Makes available 24-hour emergency care services 7 days per week;
  • Provides not more than 15 beds for acute (hospital level) inpatient care. An exception to the 15-bed requirement is made for swing-bed facilities, which are allowed to have up to 25 inpatient beds that can be used interchangeably for acute or SNF-level care, provided that not more than 15 beds are used at any one time for acute care; and
  • Provides an annual average length of stay of 96 hours per patient for acute care patients

NOTE: An exception has been made by CMS for hospice admissions to a CAH. The hospice may contract with a CAH to provide the hospice hospital benefit. Reimbursement from Medicare is made to the hospice. The CAH may dedicate beds to the hospice but the beds must be counted as part of the allowable number of CAH beds. The hospice patient does not contribute to the 96-hour annual average length of stay computation. The hospice patient can be admitted to the CAH for any care involved in their treatment plan or for respite care. The CAH negotiates reimbursement through an agreement with the hospice.
CAHEA Committee on Allied Health Education and Accreditation
A committee of the American Medical Association responsible for the accreditation of one- and two-year medical assisting programs; replaced by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in 1994.
CFR Code of Federal Regulations

The official compilation of federal rules and requirements. The Code of Federal Regulations (CFR) is the codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the Federal Government. It is divided into 50 titles that represent broad areas subject to Federal regulation. Each volume of the CFR is updated once each calendar year and is issued on a quarterly basis.

  • Titles 1-16 are updated as of January 1st
  • Titles 17-27 are updated as of April 1st
  • Titles 28-41 are updated as of July 1st
  • Titles 42-50 are updated as of October 1st

Each title is divided into chapters, which usually bear the name of the issuing agency. Each chapter is further subdivided into parts that cover specific regulatory areas. Large parts may be subdivided into subparts. All parts are organized in sections, and most citations in the CFR are provided at the section level. A list of agencies and where they appear in the CFR may be found in Appendix C of the U.S. Government Manual at: http://www.gpoaccess.gov/gmanual/index.html

When retrieving by CFR citation, the title, part, and section (or subpart) must be known. For example: "20CFR404.140" refers to:

  • Revision Year: Based on preference;
  • Title: 20;
  • Part 404;
  • Section 140; and
  • File Type: Based on preference.
CMHC Community Mental Health Center

A facility that provides the following services:

  • Outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility;
  • 24 hour a day emergency care services;
  • Day treatment, other than partial hospitalization services, or psychosocial rehabilitation services;
  • Screening for patients considered for admission to State mental health facilities to determine the appropriateness of such admission; and
  • Consultation and education services.
CMS Centers for Medicare & Medicaid Services
The federal agency that runs the Medicare Program. In addition, CMS works with the States to run the Medicaid program.
CNM Certified Nurse-Midwife
A Certified Nurse-Midwife (CNM) is an individual trained in the dual disciplines of nursing and midwifery who has successfully completed an accredited program of study and clinical experience in nurse-midwifery, and demonstrates evidence of certification according to the requirements of the American College of Nurse-Midwives (ACNM).
CNS Clinical Nurse Specialist
A Clinical Nurse Specialist (CNS) is a licensed registered nurse who has completed advanced medical training and earned a master’s degree or doctoral degree from an accredited educational institution which trains a CNS.
CPO Care Plan Oversight
Care plan oversight (CPO) is the physician supervision of a patient receiving complex and/or multidisciplinary care as part of Medicare-covered services provided by a participating home health agency or Medicare approved hospice.
CPT Current Procedural Terminology
A medical code set of physician and other services, maintained and copyrighted by the American Medical Association (AMA), and adopted by the Secretary of HHS as the standard for reporting physician and certain other services on standard transactions. CPT copyright 2007 American Medical Association. All Rights Reserved.
CRNA Certified Registered Nurse Anesthetist
A nurse who is trained and licensed to give anesthesia. A Certified Registered Nurse Anesthetist (CRNA) is a registered nurse who has completed additional training in anesthesia. A CRNA is licensed by the state in which they practice, and a CRNA:

  • Is currently certified by the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists; or
  • Has graduated from a nurse anesthesia program that meets the standards of the Council of Accreditation of Nurse Anesthesia Educational Programs and is awaiting initial certification.
DES Diethylstilbestrol
A drug given to pregnant women from the early 1940s until 1971 to help with common problems during pregnancy. The drug has been linked to cancer of the cervix or vagina in women whose mother took the drug while pregnant.
DSMT Diabetes Self Management Training
Training available for Medicare beneficiaries at risk for complications from diabetes, recently diagnosed with diabetes, or previously diagnosed with diabetes. Such patients may receive up to 10 hours of initial training during the first year and up to 2 hours of follow-up training each year thereafter.
E/M Evaluation and Management
E/M services refer to visits and consultations that physicians furnished, and its documentation is the pathway that translates a physician’s patient care work into the claims and reimbursement mechanism. For a given encounter, the selection of the appropriate level of evaluation and management (E/M) services is determined according to the code of definitions in the American Medical Association’s Current Procedural Terminology (CPT) book and any applicable documentation guidelines.
EIN Employee Identification Number
The Standard adopted by the Secretary of Health and Human Services (HHS) to identify employers in standard transactions. EIN is the adopted standard.
EMC Electronic Media Claim
A flat file format used to transmit or transport claims, such as the 192-byte UB-92 Institutional EMC format and the 320-byte Professional EMC.
FQHC Federally Qualified Health Center
A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general supervision of a physician.
HCPCS Healthcare Common Procedure Coding System
A medical code set that identifies healthcare procedures, equipment, and supplies for claim submission purposes. It has been selected for use in the HIPAA (Health Insurance Portability & Accountability Act) transactions. HCPCS Level I contain numeric CPT codes which are maintained by the AMA. HCPCS Level II contains alphanumeric codes used to identify various items and services that are not included in the CPT medical code set.
HHA Home Health Agency
An organization that gives home care services, like skilled nursing care, physical therapy, occupational therapy, speech-language pathology, and personal care by home health aides.
HPSA Health Professional Shortage Area
HPSAs have shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility).
MPFS Medicare Physician Fee Schedule
Effective January 1, 1992, the Centers for Medicare & Medicaid Services (CMS) started using the MPFS to reimburse physician services. The MPFS payment rates for an individual physician service are based on three components:
  1. Relative Value Units (RVU) - The three separate RVUs that are associated with the calculation of a payment under the MPFS include Work RVUs, Practice Expense RVUs, and Professional Liability Insurance RVUs:
    • Work RVUs reflect the relative levels of time and intensity associated with furnishing a physician fee schedule service and account for more than 50 percent of the total payment associated with a service;

    • Practice expense (PE) RVUs are the costs related to maintaining a practice such as renting office space, buying supplies and equipment, and staff costs. PE RVUs account for approximately 45 percent of the total payment associated with a given service; and

    • Professional Liability Insurance (PLI) RVUs represent the remaining portion of the total payment associated with a service.

  2. Conversion Factor (CF) - To determine the payment rate for a particular service, the sums of the three separate RVUs are multiplied by a dollar CF. The CF is updated on an annual basis according to a formula specified by statute. The formula specifies that the update for a year is equal to the Medicare Economic Index (MEI) adjusted up or down depending on how actual expenditures compare to a target rate called the Sustainable Growth Rate (SGR). The MEI is a measure of inflation, equipment, and supplies associated with the service.

  3. Geographic Practice Cost Indices (GPCI) - GPCIs are adjustments that are applied to each of the three relative values used in calculating a physician payment. The purpose of these adjustments is to account for geographic variations in the costs of practicing medicine in different areas within the country.

To find additional information about the MPFS, visit http://www.cms.hhs.gov/PhysicianFeeSched/01_overview.asp on the CMS website.
NCD National Coverage Determination
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. 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.
NIH National Institutes of Health
NIH is a part of the U.S. Department of Health and Human Services and is the primary Federal agency for conducting and supporting medical research. Composed of 27 Institutes and Centers, the NIH provides leadership and financial support to researchers in every state and throughout the world.
NF Nursing Facility
A facility which primarily provides skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or on a regular basis, health related care services above the level of custodial care to other than mentally retarded individuals.
NP Nurse Practitioner
A nurse who has 2 or more years of advanced training and has passed a special exam. A nurse practitioner often works with a doctor and can do some of the same things a doctor does.
NPI National Provider Identifier
A system for uniquely identifying all providers of healthcare services, supplies, and equipment. A term adopted by the Secretary of HHS as the standard identifier for health care providers.
NPP Nonphysician Practitioners
NPPs mean physician assistants, clinical nurse specialists, and nurse practitioners, who may (if state and local laws permit it, and when appropriate rules are followed) provide, certify or supervise therapy services. See the Medicare Benefit Policy Manual (Pub 100-02), Chapter 15, Section 220A at http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf on the CMS website.
PA Physician Assistant
A person who has 2 or more years of advanced training and has passed a special exam. A physician assistant works with a doctor and can do some of the things a doctor does.
POS Place of Service
The actual place where the service was provided, i.e., hospital, physician office, patient residence, clinic, etc.
RHC Rural Health Clinic
An outpatient facility that is primarily engaged in furnishing physicians' and other medical and health services and that meets other requirements designated to ensure the health and safety of individuals served by the clinic. The clinic must be located in a medically under-served area that is not urbanized as defined by the U.S. Bureau of Census.
SNF Skilled Nursing Facility
A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.
SSA Social Security Administration
The Federal agency that, among other things, determines initial entitlement to and eligibility for Medicare benefits.
UPIN Unique Provider Identification Number
The Unique Physician Identification Number (UPIN) provided selected information on physicians, doctors of Osteopathy, limited licensed practitioners and some non-physician practitioners who are enrolled in the Medicare Program. The UPIN has been discontinued as of June 2007 and replaced with the National Provider Identifier (NPI).

Last Updated: May 2008