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ABA BUSINESS LAW REFERENCE LIST
ACRONYMS and “HEALTH LAW-SPEAK”
ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
340B
Section 340B Drug Pricing
Program
Federal program that requires drug
manufacturers to provide outpatient drugs
to eligible health care organizations at
significantly reduced prices
ACA
Affordable Care Act of 2010
Common name of the health care reform
bill signed by President Obama in March
2010 See PPACA
ACO
Accountable Care
Organization
A healthcare organization characterized by
a payment and care delivery model that
seeks to tie provider reimbursements to
quality metrics and reductions in the total
cost of care for an assigned population of
patients
AHRQ
Agency for Healthcare
Research and Quality
Federal agency working to improve the
quality, safety, efficiency, and
effectiveness of health care
AKS
Anti-Kickback Statute
A criminal statute that prohibits the
exchange (or offer to exchange), of
anything of value, in an effort to induce (or
reward) the referral of federal health care
program business
AMC
Academic Medical Center
Health care organization linked to a
medical school or degree-granting
institution which focuses on teaching and
research
AMP
Average Manufacturer Price
The average price paid to the manufacturer
of a pharmaceutical drug by wholesalers
for drugs distributed to retail pharmacies
ASC
Ambulatory Surgical Center
Medical facility designed and equipped to
handle surgery, pain management, and
certain diagnostic procedures that do not
require overnight hospitalization
AWP
Average Wholesale Price
The average price at which pharmaceutical
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ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
drugs are purchased at the wholesale level
BPHC
Bureau of Primary Health
Care
Part of the Health Resources and Services
Administration that helps fund, staff and
support a national network of health
clinics for people who otherwise would
have little or no access to care
CAH
Critical Access Hospital
A hospital (often in rural areas) certified to
receive cost-based reimbursement from
Medicare in order to improve their
financial performance
CDC
Centers for Disease Control
and Prevention
Federal agency focused on disease control,
prevention, education and research
CERT
Comprehensive Error Rate
Testing
Program of the Centers for Medicare &
Medicaid Services to improve the
processing and medical decision making
involved with payment of Medicare claims
CHIP
Children’s Health Insurance
Program
Federal health insurance program for
children whose family income is too high
to be eligible for Medicaid. Also referred
to as the State Children’s Health Insurance
Program or “SCHIP”
CHIPRA
Children’s Health Insurance
Program Reauthorization
Act of 2009
Federal law authorizing funding and
making various changes to the Children’s
Health Insurance Program
CIA
Corporate Integrity
Agreement
A document that outlines the obligations
that a health care entity agrees to as part of
a civil settlement with a government
agency
CLIA
Clinical Laboratory
Improvement Act
Federal law addressing the oversight and
operation of clinical laboratories
CMP
Civil Monetary Penalty
Civil penalties imposed by Federal
enforcement agencies for violations of
health care laws
CMS
Centers for Medicare &
Federal agency responsible for the
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ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
Medicaid Services
oversight and regulation of the Medicare
and Medicaid programs
CoP
Conditions of Participation
Conditions governing the eligibility of an
individual or entity to be involved in
Federal health care programs, particularly
used in reference to Medicare
CON
Certificate of Need
In some states, a statement or certificate
issued by a governmental agency for
proposed construction, modification or
closure of a health facility
CORF
Comprehensive Outpatient
Rehabilitation Facility
A medical facility that provides outpatient
rehabilitation care
DEA
Drug Enforcement Agency
Federal agency responsible for regulating
the use of prohibited and controlled
substances
DME
Durable Medical Equipment
A term of art used to describe medical
equipment used in the home to aid in a
better quality of living; also a category of
providers for Federal health care programs
DMEPOS
Durable Medical Equipment,
Prosthetics, Orthotics and
Supplies
Category of Medicare reimbursement and
participation
DNR
Do Not Resuscitate
Varies by state, but generally an order to
withhold life-saving treatment in certain
circumstances
DRG
Diagnosis-Related Group
System used to classify hospital cases and
patient stays
DSH
Disproportionate Share
Hospital
Hospitals which serve large numbers of
low-income patients or patients on public
insurance
EHR
Electronic Health Record
A computerized medical record
EMR
Electronic Medical Record
See EHR
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ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
EMTALA
Emergency Medical
Treatment and Labor Act of
1986
Federal law that requires hospitals to
provide care to anyone needing emergency
healthcare treatment regardless of
citizenship, legal status or ability to pay
FCA
False Claims Act
Federal law that imposes liability on
persons and companies (typically federal
contractors) who defraud governmental
programs, including Medicare and
Medicaid
FDA
Food and Drug
Administration
Federal agency responsible for the
oversight and regulation of food,
cosmetics, drugs, biologicals, tissue
products and similar items
FDCA
Food, Drug, and Cosmetic
Act of 1938
Set of laws giving authority to the Food
and Drug Administration to oversee the
safety of food, drugs, and cosmetics
FFS
Free-for-Service
Payment model where services are
unbundled and paid for separately
FI
Fiscal Intermediary
Private company that has a contract with
Medicare to pay and handle inpatient and
some outpatient bills
FMAP
Federal Medical Assistance
Percentage
Percentages for the state and Federal share
of expenditures for certain Federal
programs
FQHC
Federally Qualified Health
Center
Community-based organizations that
provide comprehensive primary care and
preventive care, including health, oral, and
mental health/substance abuse services to
persons of all ages, regardless of their
ability to pay or health insurance status
and are designated as such, and funded by,
the Health Resources and Services
Administration
HHA
Home Health Agency
An organization that provides health care
in the home
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ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
HHS
Department of Health &
Human Services
Federal agency which includes the Food
and Drug Administration, the Centers for
Medicare & Medicaid Services and other
health care-related agencies and functions
HIE
Health Information
Exchange
The transfer of healthcare information
electronically across organizations
HIM
Health Information
Management
The practice of maintaining and caring for
health records by health care providers
HIPAA
Health Insurance Portability
and Accountability Act of
1996
Federal law that (i) protects health
insurance coverage for workers and their
families when they change or lose their
jobs, (ii) requires the establishment of
national standards for electronic health
care transactions, (iii) requires national
identifiers for providers, health insurance
plans, and employers, and (iv) protects the
privacy and security of health information
HIT
Health Information
Technology
Electronic hardware and software used to
maintain, use and transmit electronic
health/medical records
HITECH
Health Information
Technology for Economic
and Clinical Health Act
Title XIII of the American Recovery and
Reinvestment Act of 2009 addressing the
use and privacy and security of electronic
health records
HMO
Health Maintenance
Organization
An organization that provides or arranges
managed care for health insurance, selffunded health care benefit plans,
individuals and other entities as a liaison
with health care providers on a prepaid
basis
HRSA
Health Resources and
Services Administration
The primary federal agency for improving
access to health care services for people
who are uninsured, isolated or medically
vulnerable
ICD
International Statistical
Classification of Diseases
System used to classify diseases and other
health problems recorded on many types
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ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
and Related Health Problems
of health and vital records
IND
Investigational New Drug
Food and Drug Administration program by
which a pharmaceutical company obtains
permission to ship an experimental drug
across state lines (usually to clinical
investigators) before a marketing
application for the drug has been approved
LCD
Local Coverage
Determination
In the absence of a National Coverage
Determination, an item or service is
covered by Medicare at the discretion of
the Medicare contractors
LTCH
Long Term Care Hospital
Hospitals that focus on patients who, on
average, stay more than 25 days
MA
Medicare Advantage
Health plans that are approved by
Medicare and provided by private
companies
MAC
Medicare Administrative
Contractor
A company under contract with the
Federal government to handle claims
processing for Medicare services
MedPAC
Medicare Payment Advisory
Commission
Independent Congressional agency that
advises Congress on issues affecting the
Medicare program
MIC
Medicaid Integrity
Contractors
Entities that provide anti-fraud education
to Medicaid providers and identify
overpayments by conducting post-payment
audits of Medicaid claims
MIP
Medicare Integrity Program
Medicare antifraud initiative
NCD
National Coverage
Determination
Nationwide determination of whether
Medicare will pay for an item or service
NDC
National Drug Code
A unique product identifier for
pharmaceutical drugs intended for human
use
NIH
National Institutes of Health
Primary Federal agency responsible for
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ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
biomedical and health-related research
NPI
National Provider Identifier
A unique 10-digit identification number
issued to health care providers by the
Centers for Medicare & Medicaid Services
OCR
Office for Civil Rights
Department of Health and Human Services
agency responsible for, among other
things, enforcing HIPAA’s privacy and
security standards
OIG
Office of Inspector General
Department of Health and Human Services
agency dedicated to combating fraud,
waste and abuse and improving the
efficiency of health care programs;
enforces health care fraud statutes, such as
the Anti-Kickback Statute
OTC
Over the Counter
Pharmaceutical drugs that may be sold
directly to a consumer without a
prescription from a healthcare professional
PECOS
Provider Enrollment Chain
and Ownership System
Online system for enrolling in Medicare
PHI
Protected Health Information
For purposes of HIPAA, any information
about health status, provision of health
care, or payment for health care that can be
linked to a specific individual
PHRMA
Pharmaceutical
Manufacturers and
Researchers of America
Trade group for the pharmaceutical
industry; publishes a code of conduct for
manufacturers
PHS Act
Public Health Service Act of
1944
Established the Public Health Service,
which includes health-related various
agencies
PPACA
Patient Protection and
Affordable Care Act of 2010
Official name of the health care reform bill
signed by President Obama in March 2010
See ACA
PPS
Prospective Payment System
Means of determining insurance payments
based on predetermined prices, commonly
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ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
from Medicare. Payments are typically
based on codes provided on the insurance
claim
P4P
Pay for Performance
Payment concept under which providers
are rewarded for meeting pre-established
targets for delivery of healthcare services
QIO
Quality Improvement
Organization
Private entities that work under the
auspices of the Centers for Medicare &
Medicaid Services to monitor the
appropriateness, effectiveness, and quality
of care provided to Medicare beneficiaries
RAC
Recovery Audit Contractor
Program in which private contractors
identify and recover improper Medicare
payments paid to healthcare providers
under fee-for-service Medicare plans
RHC
Rural Heath Clinic
A clinic located in a rural, medically
under-served area that has a separate
reimbursement structure under the
Medicare and Medicaid programs
RHIO
Regional Health Information
Organization
A multistakeholder organization created to
facilitate health information exchange
among stakeholders of that region's
healthcare system
SAMHSA
Substance Abuse and Mental
Health Services
Administration
Department of Health and Human Services
agency charged with improving the quality
and availability of prevention, treatment,
and rehabilitative services in order to
reduce illness, death, disability, and cost to
society resulting from substance abuse and
mental illnesses
SNF
Skilled Nursing Facility
Place of residence for people who require
constant nursing care and have significant
deficiencies with activities of daily living
The Stark
Law
The Physician Self-Referral
Statute
Federal law named for former
Congressman Pete Stark that restricts
physician referral patterns and the types of
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ACRONYM/
JARGON
MEANING
REFERENCE (IF ANY)
business relationships into which
physicians may enter
URAC
Utilization Review
Accreditation Commission
Nonprofit organization promoting
healthcare quality by accrediting
healthcare organizations
WAC
Wholesale Acquisition Cost
The list price paid by a wholesaler,
distributor and other direct accounts for
pharmaceutical drugs purchased from the
wholesaler's supplier. Generally, it is the
price put by the manufacturer of drug
before any rebates, discounts, allowances
or other price concessions are offered by
the supplier of the product
ZPIC
Zone Program Integrity
Contractor
Program established by the Centers for
Medicare & Medicaid Services in which
contractors combat fraud, waste, and abuse
in the Medicare program
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