Acronyms and Industry Terms for the PCC Community

The 21st Century Cures Act is a United States law enacted by the 114th United States Congress in December 2016. Among health care providers, it is known for spelling out additional regulations prohibiting Information Blocking.

• FDA: 21st Century Cares Act
• PCC: Information Blocking Regulations in the 21st Century Cares Act

The American Academy of Pediatrics is an American professional association of pediatricians.

• www.aap.org

The Affordable Care Act, also known as Obamacare, is a United States federal statute that in addition to expanding healthcare coverage, includes several laws and initiatives that affect pediatrics. For example, the new ACA standards for categorizing CARC codes means that pediatric billers will see a plain-English “business scenario” on ERAs from payers.

• ACA at Medicaid.gov

American Recovery and Reinvestment Act of 2009. Pediatric practices often refer to ARRA when they mean the EHR Medicaid and Medicare Incentive Program, which was established by ARRA.

An internal PCC term. A batch represents an under-the-hood custom claim configuration on your PCC system. All the claims in a batch use the same claim configuration, so a batch might be named for a large group of payers. If your practice has an unusual claim configuration need, PCC’s EDI configuration specialists sometimes create a custom batch. Your list of batches may also reflect claim clearinghouses or other entities.

Also sometimes referred to as “CCDA” and “CCD”, the Consolidated Clinical Document Architecture is a standardized format for transmitting health information, popularized by Meaningful Use requirements.

PCC and other vendors use C-CDA-formatted files to transmit medical information. You can create a C-CDA for a patient record using the Summary of Care Record Report or for a single visit using the Patient Visit Summary. Patients and families can export a C-CDA from MyKidsChart. PCC even includes a C-CDA Batch Export Tool.

Centers for Medicare and Medicaid Services

• www.cms.gov

Current Procedural Terminology. A CPT code is one of over 7,000 5-digit codes that describe procedures and services performed by health care providers. CPT is the primary procedure code set used to communicate with payers for billing purposes. CPT is maintained by the American Medical Association.

Electronic Claim Submission. When a PCC system sends billing information to a payer and then receives acknowledgement and responses. See EDI.

Electronic Data Interchange. For the PCC community, EDI refers to all manner of electronic communication between a medical practice and third parties. For example: electronic claim submission (ECS), automated insurance eligibility checking, immunization registry submissions, and electronic personal billing.

Electronic Encounter Form. After charting a visit in PCC EHR, a user clicks the “Bill” button to review the procedure and diagnoses and send the visit to billing. The first screen they see in the Bill window displays charted and optional procedure and diagnoses, and is called the “Electronic Encounter Form” or EEF because it mimics the purposes of a paper encounter form, or “superbill”.

Electronic Health Record. EHR, also sometimes called EMR for Electronic Medical Record, usually refers to the software and services that support a medical institution’s tracking of patient electronic health records. PCC EHR is the name of the suite of electronic health record software and services developed and supported by PCC.

In PCC’s first software suite, Partner, the family account editor was called fame. The name is an acronym for Family Editor. In PCC EHR, users edit family and account information in components in the patients chart or in tools like Patient Checkin.

First Data Bank is the vendor who supplies electronic prescribing and medication management features to PCC EHR. When you click on “PCC eRx” in a patient’s chart, you use a product designed by a cooperative agreement between PCC and FDB.

Geographic Practice Cost Index. A series of coefficients used to adjust the RVUs of a CPT based on a practice’s location (generally state-level).

Health Care Financing Administration, established in 1977. HCFA (pronounced “HIC-fuh”) may also refer to the HCFA 1500 form, a standardized claim form required by insurance companies for claim submissions.

The Health Information Portability and Accountability Act is a set of policies, procedures and guidelines that were passed into law in 1996.

HIPAA has provisions for maintaining your health insurance when you switch employers, it created guidelines around medical savings accounts, and effected other aspects of healthcare.

When most people talk about HIPAA, however, they are talking about the Title II sections on privacy, rules around information transactions, and security

For more information, read HIPAA, Security Risk Assessments, and the Pediatric Practice.

Health Level Seven is an international set of data format standards for the use of exchanging health information.

• www.hl7.org

International Classification of Diseases, 10th Revision. ICD-10 is a code set published by the World Health Organization that is used by doctors and clinicians to classify diseases and health problems. ICD-10 is the required code set for diagnosis reporting for billing purposes, replacing ICD-9 on October 1st, 2015.

Logical Observation Identifiers Names and Codes. LOINC is a database and universal standard for identifying medical laboratory observations. PCC uses LOINC codes to indicate the discrete tests used inside Lab Orders, as well as for reporting purposes.

• www.loinc.org

Meaningful Use is a set of standards, best known for its incorporation into the EHR Medicaid Incentive programs that are part of ARRA, which aims to:

• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and family
• Improve care coordination, and population and public health
• Maintain privacy and security of patient health information

For more information, visit HealthIt.gov’s Definitions Page for Meaningful Use.

The National Committee for Quality Assurance is a licensing body that oversees and adjudicates a PCMH certification process. The Meaningful Use program (EHR Medicaid Incentive Program) includes some of the NCQA’s Clinical Quality measures.

In PCC’s first software suite, Partner, the patient account editor was called notjane. The name is a tongue-in-cheek acronym for Not Just Another Editor. In PCC EHR, users edit patient and account information in components in the patient’s chart or in tools like Patient Checkin.

On-Demand Formulary, shortened to ODF, an on-demand, plan-level formulary lookup service provided by Surescripts. This service is integrated into PCC eRx and runs automatically when you create a prescription.

PCC stands for Physician’s Computer Company, a pediatric-focused software and services company located in Winooski, VT. PCC develops an award winning, best-of-class pediatric EHR, the most powerful billing and practice management system available, and offers unlimited, 365-day support as well as free consultation and resources for any challenge facing a pediatric practice.

Patient Centered Medical Home.

PCMH encompasses a philosophy of patient care as well as a set of standards. It is an approach to care where “practices seek to improve the quality, effectiveness, and efficiency of the care they deliver while responding to each patient’s unique needs and preferences.” (AAFP.org)

Various state and local organizations, insurance carriers, and other governing bodies have adopted the PCMH standard and created paid incentive programs for practices that implement these principles.

• More on becoming a Patient Centered Medical Home
• PCC’s PCMH Wiki

Protected Health Information is a term often used for all of a patient’s private medical records. More specifically, as defined by HIPAA, PHI means any information about health status, provision of health care, or payment for health care that is created or collected by a “Covered Entity” (or a Business Associate of a Covered Entity), and can be linked to a specific individual.

In PCC’s first software suite, Partner, the tool for posting insurance payments was called pip. The name is an acronym for Post Insurance Payments.

Resource-Based Relative Value Unit, shortened to RVU.

Real-Time Prescription Benefit, shortened to RTPB, an on-demand, patient-specific formulary lookup service provided by Surescripts. This service is integrated into PCC eRx and runs automatically when you create a prescription.

Relative Value Unit, shorthand for RBRVU. Relative Value Units represent the “score” given to a CPT by CMS to determine the fee paid by Medicare. Used by payers to set fee schedules and more.

In PCC’s previous software suite, the scheduler was called SAM, which is an acronym for Scheduling Appointment Minder. In PCC EHR, users schedule appointments in the Appointment Book.

A Security Risk Assessment (SRA) is when a practice performs an assessment of security risks to patient PHI and creates or reviews policies for protecting that PHI. A pediatric practice performs an initial SRA when first implementing their HIPAA policies. They should also perform an annual SRA to review their policies and make adjustments. For more information, read HIPAA, Security Risk Assessments, and the Pediatric Practice.

The vendor who provides secure electronic information exchange services for e-prescribing.

Technical Solutions Team. At PCC, the TST are those PCC Support members who are experts in technical subjects such as computer networking, hardware, operating systems, and related needs.