CMS
Centers for Medicare and Medicaid Services
COB
Coordination of benefits
COBRA
Consolidated Omnibus Budget Reconciliation Act (federal act)
COC
Certificate of Coverage
DME
Durable Medical Equipment
DUR
Drug Utilization Review
DXL
Diagnostic X-ray and Lab
E&I
Experimental and Investigational
EDI
Electronic Data Interchange
EFT
Electronic Funds Transfer
EOB
Explanation of Benefits
ESRD
End-Stage Renal Disease
FFS
Fee For Service
HCFA
Health Care Financing Administration (now CMS, a federal agency)
HIPAA
Health Insurance Portability and Accountability Act (federal act and state law)
HMO
Health Maintenance Organization
IRMAA
Income Related Monthly Adjustment Amount
LTC
Long-Term Care
MA
Medicare Advantage
MSP
Medicare Secondary Payer
OOA
Out-of-Area
OOP
Out-of-Pocket
OV
Office Visit
PCP
Primary Care Physician (provider)
PDL
Preferred Drug List
PDP
Prescription Drug Plan
PHI
Protected Health Information
PHIP
PERS Health Insurance Program
POS
Point-Of-Service
PPACA
Patient Protection and Affordable Care Act (Health Care Reform)
PPO
Preferred Provider Organization
Rx
Prescription Drug
SHIBA
Senior Health Insurance Benefits Assistance Program (a state of Oregon agency)
SNF
Skilled Nursing Facility
U&C, R&C, UCR
Usual and Customary; Reasonable and Customary; Usual, Customary and Reasonable
UR
Utilization Review
WHCRA
Women’s Health and Cancer Rights Act
YTD
Year-To-Date