Glossary and Acronym List

10.1.24 - Glossary and Acronym List (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) ABN - Advance Beneficiary Notice of Non-Coverage Admission Date - For HH PPS, the date of the first service delivered by the HHA in a period of care or a series of continuous periods. It is placed in the Admission/Start of Care Date field on the institutional claim. Admission Period – The period between the From date of a Notice of Admission and the discharge date. An admission period may contain several 30-day periods of care and their corresponding claims. A/B MAC (A) - A/B MACs processing hospital claims. A/B MAC (HHH) - A/B MACs processing all Home Health and Hospice claims. CBSA - Core Based Statistical Area CCN - CMS certification number Claim - The transaction submitted to receive payment for an HH PPS 30-day period of care. CLIA - Clinical Laboratory Improvement Amendments CMS - The Center for Medicare & Medicaid Services, the Federal Agency administering the Medicare program. CWF - Common Working File DCN - Document Control Number DME - Durable Medical Equipment. DME MAC - DME Medicare Administrative Contractor - 4 Medicare contractors nationally processing DME on professional claim formats. DMEPOS - Durable Medical Equipment, Prosthetics, Orthotics and Supplies. DOEBA - Date of Earliest Billing Activity DOLBA - Date of Latest Billing Activity Grouper - A software module that uses claim and assessment information for payment classification. For HH PPS, this data is grouped to determine HHRGs and corresponding HIPPS codes. HCPCS Code(s) - Healthcare Common Procedure Coding System. Coding for services or items used in the HCPCS/Accommodation Rates/HIPPS Rate Codes field on institutional claim formats. HH - Home Health HHA(s) - Home Health Agency(ies) HH PPS - Home Health Prospective Payment System HHRG - Home Health Resource Group. One of the case-mix groups that determine HH PPS payment rates. HIPAA - Health Insurance Portability and Accountability Act HIPPS - Health Insurance Prospective Payment System. Coding used in the HCPCS/ Accommodation Rates/HIPPS Rate Codes field on institutional claim formats to represent case-mix groups in certain prospective payment systems. ICD - International Classification of Diseases LUPA - Low Utilization Payment Adjustment. MAC - Medicare Administrative Contractor, one of the contractors processing Medicare claims. National Standard Per Visit Rates - National rates for each of the 6 home health disciplines based on historical claims data. These rates are used in payment of LUPAs. NOA – Notice of Admission NUBC - National Uniform Billing Committee OASIS - Outcome and Assessment Information Set. The HH patient assessment instrument. Outlier - An addition to payment in cases where costs of services delivered are estimated to exceed a fixed loss threshold. PPS - Prospective Payment System. Medicare payment for medical care based on pre- determined payment rates or periods, linked to the anticipated intensity of services delivered and/or beneficiary condition. Pricer - Software modules in Medicare claims processing systems used to calculate payments under prospective payment systems. RA - Remittance Advice Revenue Code - Four position payment codes for services or items placed in the Revenue Codes field on institutional claim formats. An “x” in the last digit of revenue codes means that value can vary from 0-9. TOB - Type of Bill (e.g., 032x, 034x). Coding representing the nature of each institutional claim (i.e., type of provider, such as home health; frequency of bill) - an “x” in the last digit of the TOB means that value can vary from 0-9.