Here are a few terms and abbreviations that Medicare has included in its recent transmittals. I’ve also included a few acronyms that might help guide you when you are trying to weave yourself through the Medicare website.

ABN: Advance Beneficiary Notice—(Used on Medicare claims to indicate financial liability (GA—patient responsibility GZ---provider/supplier responsibility)

BP: Medicare Provider Benefits Manual, Pub 100-02

CHC: Certified in Healthcare Compliance

Clinician: Refers only to a physician, non-physician practitioner (NPP), occupational/physical therapist or speech and language pathologist

CP: Medicare Claims Processing Manual, Pub 100-04

Contractor:(Medicare) a Part A or B Payor but also other parties/entities utilized by Medicare to audit, investigate, administer specific Medicare programs, payors or providers/suppliers

CORF: Comprehensive Outpatient Rehabilitation Facility

CR: Change Request: Medicare’s Communication Tool with Contractors; it has a four digit number following the alpha characters e.g. CR 5478

FI: Fiscal Intermediary (Medicare Part A Payor)

LCD: Local Coverage Determination: A document produced by the local contractor detailing medically necessary services, documentation requirements and other provider/supplier guidances

MPFS: Medicare Physician Fee Schedule

National Coverage Decision: A document that relates the decision made by CMS relating to national policy for medically necessary services and other provider, payor and supplier guidances

NEMB: Notice of Exclusion from Medicare Benefits- a notice provided to a beneficiary regarding a non-covered item/service

Non-Physician Practitioner: Refers only to physician assistants, clinical nurse specialists and nurse practitioners (per state and local law may provide or supervise therapy)

OPT: Outpaptient Physical Therapy Provider (Rehab Agency-PT Services)

ORF: Other Rehabilitation Facility (Rehab Agency- more than PT Services)

OTPP: Occupational Therapist in Private Practice

Physician: Medical doctor, doctors of: osteopathy, podiatric medicine and optometry (low vision services only); CMS: no dentists or chiropractors

PI: Medicare Program Integrity Manual, Pub 100—08

PTPP: Physical Therapist in Private Practice

NEMB: Notice of Exclusion from Medicare Benefits

Qualified Personnel: Meets requirements as a therapist with the exception of licensure

Qualified Professional: OT,PT, SLP, physician/NPP licensed by the state and PTA/OTA when licensed by the state and when working under the supervision of an OT/PT

Transmittal: CMS’ notice of the need to change information in the appropriate CMS Manual (s) e.g. Transmittal-R63BP

• R= Prescript on a Transmittal that has been revised
• N= Prescript on a Transmittal that is new
• D= Prescript on a Transmittal that has been deleted
• BP= Postscript on a Transmittal indicating that the information is located in the BP Manual
• CP= Postscript on a Transmittal indicating that the information is located in the CP Manual
• PI= Postscript on a Transmittal indicating that the information is located in the PI Manual