Glossary

What Does That Mean??

The world of healthcare has its own unique set of acronyms and terminology.  Here are some of the terms you may hear used around NEPHO and NECoMG.   Click here to download a printable version of the list below.

  • ACA – Affordable Care Act
  • ACI – Advancing Care Information
  • ACO – Accountable Care Organization
  • ACU – Accountable Care Unit
  • ADL – Activities of Daily Living
  • Administrative Fee – payment for management services; NEPHO receives Administrative Fees from several health plans; NEPHO pays an Administrative Fee to Lahey Clinical Performance Network (LCPN)
  • AHRQ – Agency for Healthcare Research and Quality
  • AP – Advanced Practitioner
  • APM – Alternative Payment Models
  • AQC – Alternative Quality Contract (name of BCBSMA’s P4P program)
  • BCBSMA – Blue Cross Blue Shield Massachusetts
  • BMC – Boston Medical Center
  • Bundled Payments – a payment rate for services related to an episode or treatment
  • CAC – Collaborative Accountable Care (name of Cigna’s P4P program)
  • CAQH – Council for Affordable Quality Healthcare
  • Capitation – a fixed per member payment made to a provider for a defined set of services and time period
  • CCF – Care Coordination Fee (component of Cigna’s P4P program)
  • CHF – Congestive Heart Failure
  • CHIA – Center for Health Information and Analysis
  • CIN – Clinically Integrated Network
  • CMS – Center for Medicare and Medicaid Services
  • COPD – Chronic Obstructive Pulmonary Disease
  • CPT – Current Procedural Terminology
  • DSRIP – Delivery System Reform Incentive Program
  • ED – Emergency Department
  • EHR – Electronic Health Record
  • EMR – Electronic Medical Record
  • EPO – Exclusive Provider Organization
  • FFS – Fee-for-Service
  • FPL – Federal Poverty Level
  • GIC – Group Insurance Commission
  • HCAS – Healthcare Administrative Solutions
  • HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems
  • HCPCS – Hospital Common Procedure Coding System
  • HEDIS – Healthcare Effectiveness Data and Information Set
  • HIE – Health Information Exchange
  • HIPAA – Health Insurance Portability and Accountability Act of 1996
  • HIT – Health Information Technology (a component of the HPHC’s QAP)
  • HMO – Health Maintenance Organization
  • HPC – Health Policy Commission
  • HPHC – Harvard Pilgrim Health Care
  • HPIP – Hospital Performance Improvement Program (component of BCBSMA’s P4P program)
  • IDN – Integrated Delivery Network
  • IPA – Independent Physician Association
  • LCPN – Lahey Clinical Performance Network
  • LCP-ACO – Lahey Clinical Performance Accountable Care Organization
  • LTACH – Long-Term Acute Care Hospital
  • LTSS – Long Term Services and Support
  • MA – Medicare Advantage
  • MACRA – Medicare Access and CHIP Reauthorization Act
  • MCO – Managed Care Organization
  • MHQP – Massachusetts Health Quality Partners
  • MIPS – Merit-Based Incentive Payment System
  • MSO – Management Services Organization OR Medical Staff Office
  • MSSP – Medicare Shared Savings Program
  • MU – Meaningful Use
  • MTM – Medication Therapy Management
  • NP – Nurse Practitioner
  • NPI – National Provider Identifier
  • NPPES – National Plan and Provider Enumeration System (to create and managed NPIs)
  • OOPHO – Out of PHO
  • P4P – Pay For Performance
  • PA – Physician Assistant
  • PBM – Pharmacy Benefit Management
  • PCC – Primary Care Clinician
  • PCMH – Patient Centered Medical Home
  • PCP – Primary Care Physician
  • PG – Press Ganey
  • PHO – Provider Hospital Organization
  • PMPM – Per Member Per Month
  • POS – Point of Service
  • POD – NEPHO Physician subgroup
  • PPO – Preferred Provider Organization
  • PTAN – Provider Transaction Access Number (Medicare-issued identifier)
  • QAP – Quality Advanced Program (name of HPHC’s P4P program)
  • R4E – Rewards for Excellence (component of HPHC’s QAP)
  • RPO – Registration of Provider Organizations
  • RAF – Risk Adjustment Factor
  • Risk Contract – contracting arrangements between health plan and providers where providers are responsible for managing the overall costs of a population. If the costs are lower than the budget, the providers share in a surplus. If the costs are higher than the budget, the providers must share in the deficit
  • RVU – Relative Value Unit
  • SCO – Senior Care Options
  • Shared Savings – contracting arrangements between health plan and providers where providers are responsible for managing the overall costs of a population. In this contract model, physicians share in the surplus only, not the deficit
  • SNF – Skilled Nursing Facility
  • THP – Tufts Health Plan
  • THPP – Tufts Health Public Plans
  • TME – Total Medical Expenditures
  • TMP – Tufts Medicare Preferred
  • UCC – Urgent Care Center
  • VBP – Value Based Purchasing