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You may have come across yet another three-letter abbreviation, Revenue Cycle Management (RCM), in this acronym-heavy HME billing industry. It stands for revenue cycle management, and it has the po...
Jehoshaphat Research is Short R1 RCM Inc. (RCM)|Market Cap: $6bn|Short Interest: 10% This... short RCM. We believe its financial accounting is so misrepresentative, its corporate governance...
해외주문도서는 고객님의 요청에 의해 주문하는 '개인 오더' 상품이기 때문에, 단순한 고객변심/착오로 인한 취소, 반품, 교환의 경우
Acronym, Definition, Description ; AAEM, American Academy of Emergency Medicine, A professional organization founded in 1993 that focuses on “promoting fair and equitable practice environments necessary to allow emergency physicians to deliver the highest quality of patient care”. ; ACA, Affordable Care Act, Landmark US healthcare law signed in 2010. Among it’s major provisions, this law provided increased Medicaid funding to states, prohibited denial of insurance coverage based on pre-existing conditions, expanded access to preventative care, and established state ‘marketplaces’ for individuals purchasing insurance. ; ACEP, American College of Emergency Physicians, A professional organization founded in 1968 that focuses on “educating and training physicians in emergency medicine to provide quality emergency care in the nation’s hospitals”. ; ACLS, Advanced Cardiovascular Life Support, A set of clinical guidelines and procedures created by the American Heart Association that address life threatening cardiovascular conditions in adult populations. It focuses on critical medications, procedures and airway techniques that can be used in different clinical scenarios. ; AI, Artificial Intelligence, Artificial intelligence is the simulation of human intelligence processes by machines, especially computer systems, for the purpose of problem-solving. ; AMA, American Medical Association, The American Medical Association (AMA) is the largest national association of medical specialty groups and other healthcare stakeholders, founded in 1847. It’s mission is to promote the art and science of medicine and the betterment of public health. ; APCD, All-Payer Claims Database, All-payer claims databases (APCDs) are large State databases that include medical claims, pharmacy claims, dental claims, and eligibility and provider files collected from private and public payers. ; APM, Alternative Payment Model, A payment model that provides added incentive payments for providing cost-effective, high quality clinical care ; AUCM, Acute Unscheduled Care Model, Developed by ACEP, the AUCM is the first, and only, emergency medicine-specific alternative payment model (APM). It was developed in response to MACRA and other federal legislation emphasizing healthcare quality over quantity as well as integrated care in which providers bear risk for outcome measures. ; BLS, Basic Life Support, Basic life support (BLS), also known as basic cardiac life support, is a care process that is initiated when someone experiences sudden cardiac arrest (SCA), respiratory distress, or an obstructed airway. It can be performed by lay people, trained bystanders, or certified first responders. ; CAH, Critical Access Hospital, A designation given to certain rural hospitals by CMS that meet specific criteria. It was created to protect rural hospitals financially and increase access to necessary medical services for people who live in rural communities with limited healthcare center options. ; CBO, Congressional Budget Office, A non-partisan governmental agency that provides economic and budgetary information to Congress. It is a part of the legislative branch of government and supports the Congressional budgetary process. ; CCIICO, Center for Consumer Information and Insurance Oversight, A program created by the Affordable Care Act to oversee the implementation of new laws related to private health insurance within the United States. This program also helps states create new health insurance market places. ; CEDR, Clinical Emergency Data Registry, The first emergency medicine wide registry developed by ACEP to internally identify best practices within the specialty of emergency medicine. It focuses on components including identifying practice patterns/trends, measuring EM outcomes and improving quality of acute care within the specialty. ; CF, Conversion Factor, The number of dollars assigned to a Relative Value Unit. ; CHIP, Children’s Health Insurance Program, A program administered by HHS that provides states with matching funds to give health insurance to families with children who don’t qualify for Medicaid. It was passed into law as part of the Balanced Budget Act of 1997 to improve health coverage in the United States. ; CMS, Centers for Medicaid and Medicare Services, A federal agency with HHS that is in charge of administering Medicare programs and collaborates with state governments to administer Medicaid, CHIP and health insurance portability standards in the United States ; COBRA, Consolidated Omnibus Budget Reconciliation Act of 1985, The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. ; CPI, Consumer Price Index, The calculated mean change in prices over time that an urban consumer pays for goods and services in the market place. It is used to calculate the average cost of living and rate of inflation in urban communities. ; CPT, Current Procedural Terminology, The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency. Developed by the AMA, the CPT terminology is the most widely accepted medical nomenclature used across the country to report medical, surgical, radiology, laboratory, anesthesiology, genomic sequencing, evaluation and management (E/M) services under public and private health insurance programs. ; DEA, Drug Enforcement Administration, A federal organization founded in 1973 that regulates and enforces controlled substance laws within the United States. ; DHS, Department of Homeland Security, A federal agency tasked with protecting national security, including national emergency response. ; E/M codes, Evaluation and Management Codes, Evaluation and management (E/M) coding is the use of CPT® codes from the range 99202-99499 to represent services provided by a physician or other qualified healthcare professional. As the name E/M indicates, these medical codes apply to visits and services that involve evaluating and managing patient health. ; EMR/EHR, Electronic Medical Record, An electronically documented record used by healthcare systems/groups/providers to gather, document, and manage health related data for individuals ; EMS, Emergency Medical Services, Also known as paramedic, ambulance, or pre-hospital services, emergency medical services are emergency medical services that provide urgent pre-hospital treatment and stabilization during transport to definitive care. ; EMTALA, Emergency Medical Treatment and Labor Act, A law enacted in 1986 by Congress to ensure public access to emergency medical care regardless of ability to pay. All Medicare-participating hospitals must adhere to this law. ; EOB, Explanation of Benefits, A document that a health plan sends to its member after a medical claim is processed. It describes key portions of the processed medical claim including the type of service provided, date of service, provider name, required payments of the member/health plan and billed charges ; ERISA, Employee Retirement Income Security Act of 1974, A federal law created to provide protection for individuals enrolled in established retirement and health insurance plans administered in the private workforce sector. It does not apply to governmental entities or plans administered outside of the United States. ; ET3, ET3, Model for EMS transport “Emergency Triage, Treat and Transport” ; FFS, Fee for Service, Type of payment where healthcare providers are paid for each service performed ; GAO, Government Accountability Office, A governmental agency that performs investigative, evaluative and auditing services for the U.S. Congress. It is part of the legislative branch of the government. ; HHS, Health and Human Services, An Executive Branch Department of the U.S. government focusing on protecting the health and promoting the well-being of people in the United States. It is administered by the Secretary of Health and Human services, who is appointed by the U.S. President. ; HIPPA, Health Insurance Portability and Accountability Act, The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. ; HMO, Health Maintenance Organization, A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. ; IDR, Independent Dispute Resolution, The “No Surprises” rules create new protections against out-of-network balance billing and establish a new process, called independent dispute resolution, which providers (including air ambulance providers), facilities, and health plans can use to resolve payment disputes for certain out-of-network charges. ; IDRE, Independent Dispute Resolution Entity, To mitigate the above, CMS brings in a third party, called an Independent Dispute Resolution Entity, to decide the final payment amount. ; KPI, Key Performance Indicator, An important quantifiable metric that can be used to measure progress towards a specified goal ; LWBS, Left Without Being Seen, ; MA, Medicare Advantage, A component of Medicare also known as ” Part C” where Medicare pays private insurers to cover Medicare benefits for their members. ; MACRA, Medicare Access and CHIP Reauthorization Act, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015. MACRA created the Quality Payment Program that: Repeals the Sustainable Growth Rate (PDF) formula, Changes the way that Medicare rewards clinicians for value over volume, Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS), and Gives bonus payments for participation in eligible alternative payment models (APMs). ; MCO, Managed Care Organization, Managed care organizations are integrated entities in the healthcare system, which endeavor to reduce healthcare expenditures costs. ; MIPS, Merit-Based Incentive Payment System, A program that helps determine Medicare payment adjustments through use of a composite performance score. The scoring categories are quality, improvement activities, cost and promotion of interoperability. ; MVP, MIPS Value Pathways, MVPs are a new, voluntary way to meet MIPS reporting requirements. Each MVP includes a subset of measures and activities that are related to a specialty or medical condition to offer more meaningful participation in MIPS. ; NSA, No Surprises Act, The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Federal agencies published two interim final regulations and another proposed rule this year to implement the law. ; OMB, Office of Management and Budget, The Office of Management and Budget (OMB) serves the President of the United States in overseeing the implementation of his or her vision across the Executive Branch. OMB’s mission is to assist the President in meeting policy, budget, management, and regulatory objectives and to fulfill the agency’s statutory responsibilities ; OPPS, Outpatient Prospective Payment System, A payment system enacted in August 2000 that CMS uses to reimburse hospitals for outpatient services. It replaced the fee-for-service system that was previously used for outpatient services areimbursement to hospitals in hopes of controlling excessive healthcare costs. ; PAC, Political Action Committee, A popular term for a political committee organized for the purpose of raising and spending money to elect and defeat candidates. ; PALS, Pediatric Advanced Life Support, A set of clinical guidelines and procedures created by the American Heart Association that address life threatening cardiovascular conditions in infant and pediatric populations. It focuses on critical medications, procedures and airway techniques that can be used in different clinical scenarios. ; PAYGO, Pay-As-You-Go, Also known as per diem insurance. A type of medical liability insurance that offers per day or per contract coverage, rather than the traditional annual coverage. ; PFS, Physicians Fee Schedule, A complete listing of fees used by Medicare to determine payment to physicians and other providers/supplies. It is created by CMS. ; PHE, Public Health Emergency, The Secretary of the Department of Health and Human Services (HHS) may, under section 319 of the Public Health Service (PHS) Act determine that: a) a disease or disorder presents a public health emergency; or b) that a public health emergency, including significant outbreaks of infectious disease or bioterrorist attacks, otherwise exists. ; PPO, Preferred Provider Organization, A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. ; QCDR, Qualified Clinical Data Registries, A Qualified Clinical Data Registry (QCDR) is a Centers for Medicare & Medicaid Services (CMS) approved vendor that is in the business of improving health care quality. These organizations may include specialty societies, regional health collaboratives, large health systems or software vendors working in collaboration with one of these medical entities. ; QPA, Qualifying Payment Amount, The median contracted rate for an item or service covered by balanced billing protections in the No Surprises Act. Several factors are used to determine this rate including the specialty, insurance market, facility type and geographical location. ; QPP, Quality Payment Program, Part of the MACRA legislation, the Quality Payment Program transforms how Medicare payments are given to providers, who can choose one of two tracks: the Advanced Alternate Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). ; RCM, Revenue Cycle Management, Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. ; REH, Rural Emergency Hospital, Rural Emergency Hospitals (REHs) are a new provider type established by the Consolidated Appropriations Act, 2021 to address the growing concern over closures of rural hospitals. The REH designation provides an opportunity for Critical Access Hospitals (CAHs) and certain rural hospitals to avert potential closure and continue to provide essential services for the communities they serve. ; RUC, AMA/Specialty Society Relative Value Scale Update Committee, The RUC is a unique multispecialty committee dedicated to describing the resources required to provide physician services which the Centers for Medicare & Medicaid Services (CMS) considers in developing Relative Value Units (RVUs). ; RVU, Relative Value Units, RVUs are the basic component of the Resource-Based Relative Value Scale (RBRVS), which is a methodology used by the Centers for Medicare & Medicaid Services (CMS) and private payers to determine physician payment. RVUs, or relative value units, do not directly define physician compensation in dollar amounts. Rather, RVUs define the value of a service or procedure relative to all services and procedures. This measure of value is based on the extent of physician work, clinical and nonclinical resources, and expertise required to deliver the healthcare service to patients. RVUs ultimately determine physician compensation when the conversion factor (CF), dollars per RVU, is applied to the total RVU. ; SAEM, Society for Academic Emergency Medicine, A professional organization founded in 1989 that focuses on improving care of the acutely injured or ill patient through research and education. ; SPA, State Plan Amendment, A proposed amendment a state submits to CMS in order to make a change to their state Medicaid program. These are then reviewed by CMS. ; UR, Utilization Review, A set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision.
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As soon as I got it back from RCM last weekend, we took it for an afternoon session around Goodwood. It was an intermittently damp day with a very greasy track. The Acronym quite literally...