Glossary of Common Healthcare Abbreviations
Efficient communication is vital for healthcare professionals in any medical setting—and that includes those working with chronic care patients. Below is a glossary of healthcare abbreviations and acronyms commonly used in care coordination settings to enhance communication and efficiency within care teams.
A
ACC | American College of Cardiology
A nonprofit medical association that awards credentials to cardiovascular specialists who meet the qualifications. Learn more.
ACO | Accountable Care Organization
A group of doctors and other healthcare providers who provide coordinated, high-quality care to their Medicare patients. Learn more.
ACO REACH | Accountable Care Organization Realizing Equity, Access, and Community Health
A CMS value-based care model launched in 2023. It replaced the Direct Contracting Model (DCM) and requires participating organizations to take on financial risk while advancing health equity through population-based payment and quality measures. Learn more.
ACP | American College of Physicians
A national organization of physicians that seeks to promote federal policy reforms that benefit the practice of internal medicine. Learn more.
ACP | Advance Care Planning
Discussing and preparing for future medical care in case the patient becomes unable to communicate their preferences. Learn more.
ADL | Activities of Daily Living
The basic tasks performed on an everyday basis that are required for independent living.
AMA | American Medical Association
A professional association and group of lobbying physicians and medical students. Learn more.
APCM | Advanced Primary Care Management
A comprehensive, team-based approach to delivering primary care that emphasizes proactive, coordinated, and patient-centered services by integrating population health strategies, data analytics, behavioral health, and more. Learn more.
APM | Alternative Payment Model
A CMS payment approach that ties reimbursement to quality and cost outcomes instead of service volume. Examples include Accountable Care Organizations (ACOs), bundled payments, and primary care initiatives. Providers in qualifying Advanced APMs may earn a 5% Medicare incentive and be exempt from MIPS reporting. Learn more.
APRN | Advanced Practice Registered Nurse
A licensed clinician with advanced education and clinical training, authorized to diagnose, treat, and manage care independently. Learn more.
AUDIT-C | Alcohol Use Disorders Identification Test
A screening tool meant to assess alcohol-related issues and consumption habits.
AWV | Annual Wellness Visit
A preventive health assessment for Medicare beneficiaries that focuses on proactively managing overall health. Learn more.
B
BHCM | Behavioral Health Care Manager
Facilitates communication among a Collaborative Care team and acts as the lead contact for the patient. Learn more.
BHI | Behavioral Health Integration
A care management program that coordinates mental health, substance use, and primary care services to provide comprehensive, patient-centered care that addresses the full spectrum of behavioral and physical health needs. Learn more.
BMI | Body Mass Index
A screening tool that measures the ratio of a patient’s height to their weight to estimate body fat percentage.
BPCI | Bundled Payments for Care Improvement
A CMS payment initiative that combined all services for a defined episode of care into a single bundled payment. Providers shared in savings or losses based on cost efficiency and quality outcomes. BPCI included Classic and Advanced models, but the program has since ended. It represented an early step in Medicare’s shift toward value-based care, and its lessons informed later models such as ACO REACH and other CMS innovation programs. Learn more.
C
CARC | Claim Adjustment Reason Codes
Standardized codes used in healthcare billing to explain why claims are adjusted, reduced, or denied. Appearing on Explanations of Benefits (EOBs) and Electronic Remittance Advices (ERAs), CARC codes support denial management, compliance, and revenue cycle optimization. Learn more.
CCD | Continuity of Care Document
A standardized electronic patient summary built on HL7’s Clinical Document Architecture (CDA). It includes demographics, clinical data, medications, allergies, and care plans to support interoperability, care transitions, and CMS reporting requirements. Learn more.
C-CDA | Consolidated Clinical Document Architecture
A healthcare data standard created by HL7 for structuring and exchanging electronic clinical documents such as discharge summaries, consultation notes, and care plans. It uses standardized vocabularies like SNOMED CT, LOINC, and UCUM to ensure consistent data across EHR systems. While not a billing standard, C-CDA supports care coordination, regulatory compliance, and quality reporting, and remains widely used alongside newer standards like FHIR. Learn more.
CCDT | Care Coordination Data Template
A standardized framework for documenting and sharing patient care coordination information. It captures demographics, clinical data, care team details, social determinants of health (SDOH), and care plans to improve interoperability, support value-based care, and meet CMS reporting requirements. Learn more.
CCM | Chronic Care Management
Care coordination for patients with two or more chronic conditions expected to last at least 12 months (or until death), and that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. Learn more.
CHI | Community Health Integration
Healthcare services integrated within community settings to enhance access, improve health outcomes, and address social determinants of health (SDOH) by linking individuals with local resources and support. Learn more.
CIN | Clinically Integrated Network
A group of healthcare providers who collaborate to improve care quality and reduce costs through shared protocols, data, and governance. Learn more.
CMS | Centers for Medicare & Medicaid Services
Healthcare services integrated within community settings to enhance access, improve health outcomes, and address social determinants of health (SDOH) by linking individuals with local resources and support. Learn more.
CNA | Certified Nursing Assistant
Works under the supervision of a licensed nurse to aid patients with tasks such as daily living activities and mobility. Learn more.
CNM | Certified Nurse-Midwife
An advanced practice registered nurse who focuses on gynecologic and family planning services, as well as primary care. Learn more.
CNS | Clinical Nurse Specialist
An advanced practice registered nurse (APRN) who can advise patients about specific conditions or treatment plans. Learn more.
COB | Coordination of Benefits
The insurance process that determines which health plan pays first when a patient has multiple coverages. The primary insurer pays first, while the secondary insurer may cover remaining eligible costs. Proper COB handling prevents duplicate payments, reduces denials, and ensures accurate billing. Learn more.
CoCM | Collaborative Care Model
A comprehensive approach to healthcare that integrates mental and physical health services and specialists. Learn more.
CPC+ | Comprehensive Primary Care Plus
A CMS advanced primary care model (2017–2021) that provided practices with care management fees, prospective payments, and performance incentives in exchange for enhanced care delivery requirements. CPC+ was designed to strengthen primary care and inform future value-based care models like Primary Care First (PCF). Learn more.
CPM | Continuous Passive Motion
A type of therapy most commonly used post-surgery that allows for machines to passively move joints to promote recovery of joint range of motion.
CPT | Current Procedural Terminology
A standardized language under Level I of HCPCS that serves to correlate codes with certain healthcare services. Learn more.
CTBS | Care Team-Based Services
Non–face-to-face, technology-enabled services provided by physicians and clinical staff to manage patient care between visits. They include Chronic Care Management (CCM), Principal Care Management (PCM), Remote Monitoring (RPM), and virtual communication codes. CTBS reimburse team-based care that supports access, coordination, and value-based care delivery. Learn more.
D
DX | Diagnosis
The identification of a condition through an analysis of symptoms.
E
EHR | Electronic Health Records
A digital version of a patient’s overall medical history that the provider maintains on a rolling basis.
E/M | Evaluation and Management Coding
A category of CPT codes used by healthcare providers to bill for office visits, consultations, and other patient encounters. E/M code selection is based on visit type, time spent, or medical decision-making complexity. Learn More.
EMR | Electronic Medical Records
A digital version of a patient’s medical history from a single care provider.
EOB | Explanation of Benefits
A statement issued by a health insurance payer after processing a claim. It outlines the services billed, the allowed amount, insurer payments, and the patient’s financial responsibility. EOBs help providers reconcile claims, track denials, and manage revenue cycle operations. Learn more.
EOM | The Enhancing Oncology Model
A CMS value-based care program launched in 2023 to improve quality and coordination of cancer treatment while lowering costs. It replaced the Oncology Care Model (OCM) and focuses on 6-month episodes of care for patients receiving chemotherapy for seven common cancer types. EOM provides oncology practices with monthly Enhanced Oncology Services (EOS) payments, requires equity-focused care delivery, and holds participants accountable for cost and quality performance. Learn more.
ERA | Electronic Remittance Advice
The electronic version of an Explanation of Benefits (EOB), transmitted in the HIPAA 835 format. It details how claims are paid, adjusted, or denied, including CARC and RARC codes. ERA/835 files support payment posting, denial management, compliance, and automation in the healthcare revenue cycle. Learn more.
F
FFS | Fee for Service
A traditional healthcare reimbursement model where providers are paid separately for each service or procedure delivered. Common in Medicare and private insurance, Fee-for-Service rewards volume over outcomes and remains foundational in billing systems that use CPT and HCPCS codes. Learn more.
FHIR | Fast Healthcare Interoperability Resources
A healthcare data standard created by HL7 to enable secure, web-based exchange of electronic health information. It organizes data into modular “resources” such as Patient, Observation, and Claim, which can be shared through APIs using formats like JSON or XML. FHIR integrates with coding systems including SNOMED CT, LOINC, and UCUM, and underpins federal interoperability rules in the United States. By improving data sharing, FHIR supports patient access, care coordination, quality reporting, and value-based care. Learn more.
FQHC | Federally Qualified Health Center
A community-based provider that delivers primary care in underserved areas, supported by federal funding and enhanced Medicare/Medicaid reimbursement. Learn more.
G
GAD-7 | Generalized Anxiety Disorder-7
A diagnostic tool used to screen patients for symptoms of anxiety disorders in primary care settings. Learn more.
GNA | Geriatric Nursing Assistant
Assists elderly patients with daily living activities and tracks any changes in physical and mental health status. Learn more.
GP | General Practitioner
A healthcare professional who serves as the main point of contact for routine medical issues and can refer patients to specialists as needed. Also commonly referred to as a “primary care provider.”
H
HCC | Hierarchical Condition Category
Medicare risk adjustment model used to estimate future healthcare costs based on a patient’s documented chronic conditions and demographics. Learn more.
HCPCS | Healthcare Common Procedure Coding System
A standardized set of codes divided into two main levels used to report healthcare services and supplies to insurers for billing purposes. Learn more.
HEDIS | Healthcare Effectiveness Data and Information Set
A standardized set of performance measures developed by NCQA to evaluate healthcare quality, access, and outcomes across health plans, provider networks, and care organizations. Learn more.
HIE | Health Information Exchange
The secure electronic sharing of patient health information between authorized providers, hospitals, payers, and other healthcare organizations to improve care coordination, safety, and outcomes. Learn more.
HIPAA | Health Insurance Portability and Accountability Act
Federal law that protects sensitive health information from being disclosed without the patient’s explicit consent.
HL7 | Health Level Seven International
A global nonprofit that develops standards for electronic health information exchange. Its frameworks — including HL7 v2, CDA, and FHIR — allow hospitals, payers, and vendors to share patient data, support interoperability, and meet value-based care requirements. Learn more.
I
ICD-10 | International Classification of Diseases
A standardized system of alphanumeric codes used to classify diagnoses, symptoms, and conditions for medical billing, risk adjustment, and quality reporting. Learn more.
IDN | Integrated Delivery Network
A healthcare system that unifies hospitals, clinics, and providers under shared administration to coordinate care and manage costs. Learn more.
IPA | Independent Practice Association
A network of independent healthcare providers that contracts collectively with payers while allowing each member to retain ownership of their own practice. Learn more.
IPPE | Initial Preventive Physical Exam
A preventive visit that serves to promote good health through disease detection and prevention. Also referred to as the “Welcome to Medicare” visit. Learn more.
K
KCC | Kidney Care Choices
A CMS value-based care model launched in 2022 to improve outcomes for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The model builds on the retired Comprehensive ESRD Care (CEC) Model and expands participation to nephrology practices, dialysis facilities, and care management organizations. KCC aligns financial incentives with quality measures to encourage earlier intervention, better care coordination, and improved patient outcomes. Learn more.
L
LCSW | Licensed Clinical Social Worker
A licensed mental health professional trained to provide therapy, assessments, and care coordination. Learn more.
LOINC | Logical Observation Identifiers Names and Codes
A universal standard for coding laboratory tests, clinical measurements, and health observations. Each LOINC code represents a specific type of result, ensuring consistency across electronic health records (EHRs), laboratories, and health systems. While not used for billing, LOINC supports interoperability, quality reporting, population health, and value-based care by making clinical data comparable and sharable. Learn more.
M
Medicare Advantage | MA
An alternative to traditional Medicare in which private health plans contract with CMS to deliver Part A and Part B benefits. Plans receive capitated payments from CMS and may offer prescription drug coverage and supplemental benefits. MA supports innovation models like VBID and plays a key role in advancing value-based care. Learn more.
MCO | Managed Care Organization
A healthcare network that coordinates services and controls costs through fixed payments and provider contracts. Learn more.
MDM | Medical Decision Making
The complexity of clinical judgment used by providers to diagnose, assess, and manage patient care. It is a foundational component in selecting CPT codes for Evaluation and Management (E/M) billing and reimbursement. Learn more.
MIPS | Merit-based Incentive Payment System
A federal program run by the Centers for Medicare & Medicaid Services (CMS) that adjusts Medicare reimbursements based on clinician performance in four categories: Quality, Improvement Activities, Promoting Interoperability, and Cost, resulting in positive, neutral, or negative payment adjustments. Learn more.
MRI | Magnetic Resonance Imaging
Method of medical imaging that produces detailed images of internal structures within the human body.
MSO | Management Services Organization
An entity that handles the non healthcare-related work required to run a medical practice, such as revenue cycle management or accounts payable. Learn more.
MSSP | Medicare Shared Savings Program
A CMS value-based care model where groups of providers, called Accountable Care Organizations (ACOs), work together to improve quality and lower costs for Medicare beneficiaries. Successful ACOs can earn shared savings, while those in higher-risk tracks may also share in losses. Learn more.
N
NDC | The National Drug Code
A unique 10- or 11-digit identifier assigned by the FDA to every drug product in the United States. Divided into three segments—labeler, product, and package—the NDC functions as a universal product number for medications. NDCs are used in drug labeling, electronic prescribing, claims processing, and the Medicaid Drug Rebate Program. While focused on product identification rather than clinical intent, NDCs play a critical role in medication safety, reimbursement, and public health monitoring. Learn more.
NP | Nurse Practitioner
A nurse with advanced education and clinical training who is able to perform many of the same duties as a physician. Learn more.
NPI | National Provider Identifier
A unique 10-digit identification number issued by CMS to healthcare providers and organizations in the U.S. NPIs are required for all HIPAA-standard transactions, including billing and claims, and serve as a universal provider ID across payers and healthcare systems. Learn more.
NPP | Non-Physician Practitioner
A healthcare provider who is not a physician but can practice with or under the supervision of a licensed physician. Learn more.
P
PA | Physician Assistant
A healthcare professional who can provide patient care while working under the supervision of a licensed physician. Learn more.
PCF | Primary Care First
A CMS primary care payment model launched in 2021 that provides practices with population-based payments and performance incentives to improve patient care. PCF simplifies CPC+ by reducing payment streams, strengthening the link between performance and revenue, and qualifying as an Advanced Alternative Payment Model (APM) under QPP. Learn more.
PCM | Principal Care Management
Tailored care coordination focused on patients with a single high-risk chronic condition. Learn more.
PCMH | Patient-Centered Medical Home
A care delivery model used in primary care that emphasizes long-term patient-provider relationships, care coordination, and whole-person health management. Learn more.
PCP | Primary Care Provider
A healthcare professional who serves as the main point of contact for routine medical issues and can refer patients to specialists as needed. Also commonly referred to as a “general practitioner.”
PDMP | Prescription Drug Monitoring Program
A state-run electronic database that tracks prescriptions for controlled substances. PDMPs are used by prescribers and pharmacists to identify potential misuse, improve patient safety, and support compliance with prescribing laws and Promoting Interoperability (PI) requirements. Learn more.
PHQ-9 | Patient Health Questionnaire-9
A diagnostic tool used to screen patients for symptoms of depression in primary care settings.
PI | Promoting Interoperability
A CMS program that requires providers to use certified electronic health record (EHR) technology to support secure data exchange, patient access, e-prescribing, and public health reporting, replacing the former Meaningful Use program as part of the Quality Payment Program (QPP). Learn more.
PIN | Principal Illness Navigation
Care management that helps patients better understand their condition and guide them through the healthcare system.
POLST | Physician Orders for Life-Sustaining Treatment
A signed medical order that documents a patient’s treatment preferences for critical or end-of-life care. Unlike an advance directive, a POLST guides immediate clinical decisions and travels with the patient across care settings. Learn more.
PPP | Public-Private Partnership
An agreement between one or more public and private entities that puts forth mutual responsibilities in the promotion of shared interests.
PSH | Past Surgical History
A record that details a patient’s past surgical procedures.
PTSD | Post-Traumatic Stress Disorder
A mental health condition involving severe anxiety, nightmares, or flashbacks that stems from a traumatic or stressful event.
Q
QD | Once a Day
Indicates that a medication should be taken once a day.
QHP | Qualified Health Professional
A Qualified Health Professional (QHP) is a licensed or credentialed clinician authorized to provide or supervise specific healthcare services, often for billing, compliance, or care coordination purposes. Learn more.
QID | Four Times a Day
Indicates that a medication should be taken four times a day.
QMB | Qualified Medicare Beneficiary
A Medicare patient who qualifies for financial assistance with their Part A and Part B premiums, based on limited income and resources. Learn more.
QPP | Quality Payment Program
A CMS initiative created under MACRA that rewards clinicians for providing high-quality, cost-efficient care. QPP includes two tracks — MIPS and APMs — which determine how providers are evaluated and reimbursed for Medicare Part B services. Learn more.
R
RAF | Risk Adjustment Factor
A numerical score assigned to a Medicare beneficiary that predicts their expected healthcare costs based on documented conditions and demographics. Learn more.
RARC | Remittance Advice Remark Codes
Standardized codes used in healthcare billing to provide narrative details about claim adjustments or denials. Appearing on Explanations of Benefits (EOBs) and Electronic Remittance Advices (ERA 835), RARCs work alongside CARC codes to give providers the context needed for appeals, compliance, and revenue cycle management. Learn more.
RBRVS | Resource-Based Relative Value Scale
The reimbursement system used by Medicare and many payers to determine physician payment rates. It assigns Relative Value Units (RVUs) based on physician work, practice expense, and malpractice risk, adjusted by geography and multiplied by a conversion factor to calculate reimbursement. Learn More.
RN | Registered Nurse
A provider who works alongside physicians, administering physical exams and educating patients about their symptoms and treatment plans.
RPM | Remote Physiological Monitoring
Monitor and capture health data from patients remotely, facilitating real-time care management and adjustments to treatment plans. Learn more.
RTM | Remote Therapeutic Monitoring
Utilizes technology and real-time data to monitor and manage patient therapy remotely. Learn more.
RVU | Relative Value Unit
A standardized measure used to quantify the value of medical services for billing and reimbursement. Learn more.
S
SDOH | Social Determinants of Health
Utilizes technology and real-time data to monitor and manage patient therapy remotely. Learn more.
SNF | Skilled Nursing Facility
A facility that contains the staff and equipment needed to provide skilled nursing care, skilled rehabilitation, and other health-related services. Learn more.
SNOMED CT | Systematized Nomenclature of Medicine – Clinical Terms
A comprehensive, standardized clinical terminology used worldwide to encode medical concepts, including diagnoses, findings, procedures, anatomy, and substances. Unlike ICD-10, which is primarily for billing, SNOMED CT captures detailed clinical information for electronic health records (EHRs), interoperability, analytics, and value-based care. It is maintained by SNOMED International and adopted in more than 40 countries. Learn more.
T
TCM | Transitional Care Management
Focuses on providing support and continuity of care for patients transitioning from a hospital setting to other care environments. Learn more.
U
UCUM | Unified Code for Units of Measure
A standardized system for representing units of measure in a consistent, machine-readable format. It eliminates ambiguity by ensuring units like mg/dL, mmHg, and mL are expressed the same way across electronic health records, laboratories, and health IT systems. UCUM is used alongside LOINC, SNOMED CT, and FHIR to support interoperability, improve patient safety, enable accurate quality reporting, and strengthen value-based care initiatives. Learn more.
V
VBC | Value-Based Care
Outcome-focused care model that rewards providers for improving patient health and coordinating care effectively. Learn more.
VBID | Value-Based Insurance Design
A CMS demonstration that allows Medicare Advantage plans to vary benefits and cost-sharing to promote high-value care. By lowering costs for preventive services, chronic condition management, and evidence-based treatments, VBID aims to improve patient outcomes and reduce unnecessary spending while advancing equity in healthcare access. Learn more.
Z
Z Codes
Z codes are ICD-10-CM diagnosis codes (Z00–Z99) used to document factors that influence a patient’s health but are not diseases or injuries. They include reasons for encounters, medical and family history, and social determinants of health (SDOH) such as housing or food insecurity. While Z codes do not directly affect reimbursement, they provide valuable data for population health, quality reporting, and value-based care initiatives. Learn more.
