A&G Administrative and General
A&I Audits and Investigations
AHA American Hospital Association
APC Ambulatory Payment Classification
ARAS Audit Review and Analysis Section
ARRA American Recovery and Reinvestment Act of 2009
ASC Ambulatory Surgical Center


BBA Balanced Budget Act
BBRA Balanced Budget Reform Act
BIPA Benefits Improvement and Protection Act


CAH Critical Access Hospital
CAP Competitive Acquisition Provider
CAPD Continuous Ambulatory Peritoneal Dialysis
CAP-REL Capital-Related
CBSA Core Based Statistical Areas
CCN CMS Certification Number
CCPD Continuous Cycling Peritoneal Dialysis
CCU Coronary Care Unit
CFR Code of Federal Regulations
CHA California Hospital Association
CHPP Center for Health Plans and Providers
CMG Case-mix Groups
CMHC Community Mental Health Center
CMI Case – Mix Index
CMS Centers for Medicare & Medicaid Services
COL Column
CORF Comprehensive Outpatient Rehabilitation Facility
COS Clinical Outcomes Systems
CRNA Certified Registered Nurse Anesthetist
CRRP Child Care, Resource and Referral Development Program
CTC Certified Transplant Center


DEFRA Deficit Reduction Act of 1984
DHCS Department of Health Care Services
DHHS Department of Health and Human Services
DME Durable Medical Equipment
DPP Disproportionate Patient Percentage
DRA Deficit Reduction Act of 2005
DRG Diagnostic Related Group
DSH Disproportionate Share – Medicare


EACH Essential Access Community Hospital
ESRD End Stage Renal Disease


FCSO First Coast Service Options, Inc.
FI Fiscal Intermediary
FIM Functional Independence Measure
FQHC Federally Qualified Health Center
FR Federal Register
FRVS Fair Rent Value System
FTE Full Time Equivalent


GME Graduate Medical Education


HCFA Health Care Financing Administration
HFMA Healthcare Financial Management Association
HHA Home Health Agency
HHSA State of California – Health and Human Services Agency
HIPAA Health Insurance Portability and Accountability Act of 1996
HMO Health Maintenance Organization
HSCS Health & Safety Code Sections
HSR Hospital Specific Rate
HSRV Hospital-Specific Relative Values


I & Rs Interns and Residents
ICF Intermediate Care Facility
ICF/MR Intermediate Care Facility for the Mentally Retarded (9/96)
ICU Intensive Care Unit
IME Indirect Medical Education
INPT Inpatient
IPF Inpatient Psychiatric Facility
IRF Inpatient Rehabilitation Facility




LCC Lesser of Reasonable Cost or Customary Charges
LDP Labor, Delivery and Postpartum
LIP Low Income Patient
LOS Length of Stay
LTCH LongTerm Care Hospital
LTCRU Long Term Care Reimbursement Unit
LTCSDU Long Term Care System Development Unit


M+C Medicare + Choice (also known as Medicare Part C)
MA Medicare Advantage (previously known as M+C)
MAC Medicare Administrative Contractors
MCP Monthly Capitation Payment
MDH Medicare Dependent Hospital (10/97)
MDS-PAC Minimum Data Set for Past-Acute Care
MEA Medicare Enrollment Application
MED-ED Medical Education
MedPAC Medicare Payment Advisory Commission
MedPAR Medicare Provider Analysis and Review File Tool
MIPPA Medicare Improvements for Patients and Providers Act of 2008
MIRL Maximum Inpatient Reimbursement Limitation
MMA Medicare Prescription Drug Improvement and Modernization Act of 2003
MPD Medi-Cal Policy Division
MSA Metropolitan Statistical Area (10/97)
MS-DRG Medicare Severity Diagnosis-Related Group
MSP Medicare Secondary Payer


NF Nursing Facility
NHCMQ Nursing Home Case Mix and Quality Demonstration
NPI National Provider Identifier


OBRA Omnibus Budget Reconciliation Act of 1993
OLTC Other Long Term Care
OOT Outpatient Occupational Therapy
OPD Outpatient Department
OPO Organ Procurement Organization
OPPS Outpatient Prospective Payment System
OPT Outpatient Physical Therapy
ORF Outpatient Rehabilitation Facility
OSHPD Office of Statewide Health Planning and Development
OSP Outpatient Speech Pathology


PARD Provider Audit and Reimbursement Department
PBP Provider-Based Physician
PGBA Palmetto GBA
PIRL Peer Group Inpatient Reimbursement Limitation
PM Program Memorandum
PPP Prospective Payment Provider
PPS Prospective Payment System
PRM Provider Reimbursement Manual
PRO Professional Review Organization
PRS Provider Rate Section
PS&R Provider Statistical and Reimbursement System
PT Physical Therapy


QAFP Quality Assurance Fee Program


RCE Reasonable Compensation Equivalent
RDB Rate Development Branch
RHC Rural Health Clinic
RHQDAPU Reporting Hospital Quality Data for Annual Payment Update
RPCH Rural Primary Care Hospitals
RT Respiratory Therapy
RUG Resource Utilization Group


SCH Sole Community Hospitals
SCHIP State Children Health Insurance Program
SNF Skilled Nursing Facility
SSI Supplemental Security Income (for Long Tern Care Hospital)
SSI Supplemental Security Income (for Inpatient Rehab Facilities)


TEFRA Tax Equity and Fiscal Responsibility Act of 1982
TOPs Transitional Outpatient Payment System


UPIN Unique Physician Identification Number



W&ICS Welfare and Institutions Code Sections
WKST Worksheet
WPS Wisconsin Physician Services