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Common Terminologies in Medical Billing


Payer:             Insurance
Provider:        Hospital or Physician
SSN:               Social Security Number
PCP:               Primary Care Physician
PCL:               Professional Courtesy Letter
HMO:             Health Maintenance Organization
PPO:               Preferred Provider Organization
POS:               Point of Service
EPO:               Exclusive Provider Organization
EOB:              Explanation of Benefits
ABN:              Advance Beneficiary Notice
CMS:              Center for Medicare and Medicaid Services
COBRA:        Consolidated Omnibus Budget Reconciliation Act
DME:             Durable Medical Equipment
ESRD:            End Stage Renal Disease
ERA:              Electronic Remittance Advice
EFT:               Electronic Fund Transfer
LGHP:           Large Group Health Plan
EGHP:           Employer Group Health Plan
GEP:              General Enrollment Period
HCFA:           Health Care Financing Administration
HIPAA:          Health Insurance Portability and Accountability Act
IEP:                Initial Enrollment Period
MSP:              Medicare Secondary Payer
NP:                 Nurse Practitioner
IP:                   Inpatient
OP:                 Outpatient
PA:                 Physician Assistant
PSO:               Provider Sponsored Organization
QMB:             Qualified Medicare Beneficiary
SNF:               Skilled Nursing Facility
HHA:              Home Health Agency
WC:                Workers Compensation
VA:                 Veterans Administration
CHAMPUS:  Civilian Health and Medical Program of the Uniformed Services

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