Glossary Table

The following glossary shows athenahealth-specific terms marked with the icon.

 

 

athenahealth Term?	Term	Definition
	A/R	Stands for accounts receivable. The items and amounts that a practice expects to receive for services rendered.
	AA	Stands for anesthesiologist assistant. Also: As a modifier on the anesthesia service, AA indicates that the anesthesia was personally performed by the anesthesiologist.
	AAAA	Stands for American Academy of Anesthesiologist Assistants. Here is their website: http://www.anesthetist.org
	ABN	Stands for Advanced Beneficiary Notice. This is a waiver of liability form for Medicare patients. It is used when a provider knows or believes that Medicare won't consider a service "medically necessary" or when the provider knows or believes that Medicare will not pay for a service.
	accessory dwelling unit (ADU)	A separate housing arrangement within a single-family home. The ADU is a complete living unit and includes a private kitchen and bath.
	accounts receivable	The items and amounts that a practice expects to receive for services rendered. Same as A/R.
	ACOG	Stands for the American College of Obstetricians and Gynecologists.
	ACOG form	The standard prenatal form that most OB/GYN providers use to document the regular prenatal visits leading up to delivery. These visits are extremely quick and are documented in a flowsheet. The flowsheet tracks a series of clinical findings at each prenatal encounter. This documentation is sent to the hospital at about 36 weeks or at the onset of labor to provide information to the delivering provider about the patient's pregnancy. Also known as the ACOG Antepartum Record. athenahealth uses our own OB Episode Form to convey antepartum information to the hospital before delivery.
	adjudication (for claims)	This refers to the process that a payer uses to determine if a claim qualifies for payment.
	adjustment (contractual)	A write-off amount equal to the difference between the payment expected for a service (allowable amount) and the payment that is actually received for the service.
	advance directive	This written document states how a patient wants medical decisions to be handled in the event that the patient loses the ability to make or communicate such decisions. A healthcare advance directive may include a Living Will and a Durable Power of Attorney for healthcare.
	all-inclusive rate	A rate of payment covering all services during a hospital stay
	allowable amount	The maximum amount that a payer will pay a provider for a given service, including the patient responsibility amount (for example, copay, coinsurance, or deductible). Also expressed as the charge amount (that is, the amount that the provider charges for a given service) minus the contractual adjustment.
	allowable category	An athenahealth term. An allowable category is a group of insurance packages that use the same allowable schedule.
	allowable schedule	A table of procedure codes and their corresponding reimbursement amounts that you expect to receive as payment from a particular payer. You can manually create allowable schedules, or provide athenahealth with a spreadsheet of procedure codes and reimbursement amounts, so that athenahealth can import the schedule for you.
	ambulatory care	All types of health services that do not require an overnight hospital stay.
	ancillary service	Services needed beyond room and board charges or doctor visit charges, such as laboratory tests, therapy, surgery, and x-rays.
	anesthesia case	An athenaOne term. The anesthesia case is the means used to record and link data related to the patient's anesthesia service or procedure, so that all required information is available throughout the anesthesia billing workflow. Anesthesia cases are created using the Anesthesia Cases page or using the case data entry fields within the Time Sheet or Time Sheet Batch page.
	ANSI	Stands for American National Standards Institute. This organization develops voluntary business standards in the United States.
	ANSI 837	Electronic claim format implemented on October 16, 2003, to comply with HIPAA regulations. The 837I format is used for institutional claims. 837P format is used for professional claims.
	APC	Stands for Ambulatory Payment Classifications. This is a Medicare payment system that classifies outpatient services so Medicare can pay all hospitals the same amount.
	appeal	A process by which a patient, a provider, or a hospital can object to a health plan when there is a dispute about the health plan's decision to not pay for care.
	arbitration	A process for resolving legal disputes where an unbiased person or panel renders an opinion as to responsibility for or extent of a loss.
	ASA	ASA procedure codes are used in anesthesia billing. The required codeset is CPT-4 anesthesia procedure codes 00100-01999.
	ASP application	ASP stands for active server pages. An ASP application is a Web-based application that uses ActiveX scripting to create Web pages dynamically. An ASP application can send and receive data entered by users over the Internet using a browser program. athenaOne is an ASP application.
	assignment of benefits agreement	An agreement signed by the patient that allows the insurance company to pay the provider or hospital directly for services rendered to the patient.
	athenaClinicals	The athenahealth EMR service solution. Includes a fully customizable patient encounter form, clinical document-handling services, and a paperless workflow for patient chart administration.
	athenaCodesource	This tool allows you to search medical billing reference books, the CPT and HCPCS databases, Medicare manuals, federal guidelines, and more. The Rules engine also uses athenaCodesource to check the effective and termination dates of a procedure code against a claim's from and to dates. This tool is the product of a partnership between athenahealth and nThrive.
	athenaEnterprise	An athenahealth add-on overlay product for provider networks, integrated delivery systems, and other complex physician enterprises. It features a common patient index, extended patient privacy tools, and cross-practice reporting. The practice setting required for this feature is called "Provider Group Based Data Permissions."
	athenaMailbox	An athenahealth term. athenaMailbox is a lockbox-like service in which athenahealth receives mail and facilitates the deposit of payments on behalf of its clients. This service replaces the need for clients to purchase lockbox services from a bank and centralizes receipt and handling of remittance documents at athenahealth.
	athenaMobile	An athenahealth service solution that integrates a handheld charge capture and coding device with the athenaOne system.
	attending physician statement (APS)	Another name for medical records. Often acquired by an insurance company to determine an individual's health when applying for health coverage. Insurance companies contact physicians to obtain the records, either prior to approval or once the policy has become effective.
	authorization	A document issued by the patient's insurance plan, stating that provider services are approved by the patient's insurance plan for reimbursement or compensation. Identified by a number, called an authorization number, prior-authorization number, or certification number. See also: referral
	authorization number	The identifying number on a document issued by the patient's insurance plan, stating that provider services are approved by the patient's insurance plan for reimbursement. Also called a prior-authorization number or certification number.
	back-post	To set the post date back before the current date so that a payment has a deposit date and a post date in different months.
	batch header	An athenahealth term. A batch header is a daily summary of the patient workflow. The"daily batch header" consists of summary information entered into two athenaOne pages: Daily Batch Header - Financial and Daily Batch Header - Appointments. Completing the daily batch header provides a check-and-balance process that allows the practice to track daily patient activity reliably. Its purpose is to ensure that all cash and patient visits in a given day are accounted for.
	beneficiary	Person covered by a health insurance plan
	billing batch	An athenahealth term. A group of claims that are generated and submitted together.
	billing slip	Also called a super-bill, charge slip, or encounter billing form (EBF). This form lists the diagnosis and procedure codes used to record the details of services rendered to a patient by the provider. It may contain treatment information and procedure or service details. This form may also be used to record referral, prior authorization, and/or financial information.
	board-certified	Also called Boarded, Diplomate. Describes a physician approved by a medical specialties board (American Board of Medical Specialties) to practice a particular specialty. This rating is designed to provide consumers with quality medical care.
	bulk payment	An athenahealth term. A "bulk payment" occurs when a payer sends remittance for a single claim with multiple charges but does not specify how to apply the payments, transfers, and adjustments to each individual charge. Since the remittance covers multiple charges on a single claim, the payments, transfers, and adjustments must be distributed across the charges, so that the claim can close or move to the next appropriate status.
	cap item	An athenahealth term. The components of a capitation contract defined by the Cap Wizard Insurance tool. A cap item is the combination of a group of one or more insurance packages, a group of one or more procedure codes, a group of zero or more diagnosis codes, and a group of zero or more providers.
	capitated adjustment	An adjustment is a credit transaction applied against a patient's accounts receivable. An adjustment is described as capitated when it is applied to a service covered under an agreement whereby the provider is paid a fixed amount for each person/subscriber regardless of the costs incurred. Also: A "write-off" amount equal to the difference between the allowable amount and the charge amount.
	capitation	Alternative to the fee-for-service system for medical provider reimbursement that is based on the number of patients served by the provider (known as "covered lives"), rather than for the specific medical services provided to patients (fee-for-service).
	capitation payment	Capitation payments are lump sum, monthly payments received as reimbursement under a capitation contract. The reimbursement amount is based on the number of covered lives, rather than on the specific medical services provided to patients. athenaOne treats capitation payments as unpostable amounts because they do not represent fees for individual services, and so cannot be applied to specific open charges. Instead, capitation payments should be recorded in athenahealth as unpostable amounts in payment batches and deposit batches. Capitation payments appear as unpostable items in the Unpostable Remittance worklist and report, but they do not appear as posted payments on the Activity Wizard.
	capped charges	Charges for a procedure covered under a capitation item.
	carve-out	Refers to an arrangement between insurers in which the primary insurer pays a lump sum portion of the premiums to supply coverage for a particular type of care (procedures or services) or condition (diagnosis). In effect, the primary insurer transfers the risk associated with a type of care or condition to another insurer. Claims associated with the carve-out care are sent to the secondary insurer. The most prominent example is behavioral health. Other common carve-outs include psychiatric, rehab, chemical dependency and ambulatory services. Increasingly, oncology and cardiac services are also carve-outs.
	case management	The process of coordinating the specific health services needed by an individual to achieve the desired health outcome in a cost effective manner. Physician case managers coordinate designated components of healthcare, such as appropriate referral to consultants, specialists, hospitals, ancillary providers, and services. Case management is intended to ensure continuity of services and accessibility to overcome rigidity, fragmented services, and the misuse of medical resources. It also attempts to match the appropriate intensity of services with the patient's needs over time.
	case policy	In athenaOne, a case policy is a special type of insurance policy that covers Workers' Comp, motor vehicle accidents (MVA), other types of accidents, specialty care such as vision and mental health, and special contracts. A case policy has certain billing requirements that differ from primary and secondary coverage.
	case-sensitive	Term used in computer technology. Distinguishes between uppercase (capital) letters and lowercase letters; for example, "DOC" and "doc" are treated as two different words.
	CBO	Stands for "central billing office." At athenahealth, this department is called "Collector Services."
	CCI	Stands for Correct Coding Initiative. This is a project developed by the Centers for Medicare and Medicaid Services (CMS), to promote national correct coding methodologies and to eliminate improper coding. CCI uses coding conventions defined in the American Medical Association's Current Procedural Terminology (CPT) Manual, current standards of medical and surgical coding practice, input from specialty societies, and analysis of current coding practice.
	CCI bundling	CCI stands for Correct Coding Initiative. Bundling refers to a single payment for a group of related services. Bundled payments have become the norm in recent years and unbundled services are investigated closely by HCFA and other payers. Unbundling service charges has been a common form of fraud as defined by HCFA.
	Certificate of Medical Necessity	Medicare sometimes requires a CMN from a DMRC (durable medical equipment regional carrier) when the claim includes durable medical equipment.
	certification number	See authorization
	CHAMPUS	A healthcare coverage program for service men and women provided by the US military that covers medical necessities only. Superseded by TRICARE. It provides authorized in-patient and out-patient care from civilian sources, on a cost-sharing basis. Retired military, and dependents of active-duty, retired and deceased military are also covered under CHAMPUS. See also TRICARE.
	charge amount	Also referred to as the fee schedule amount. The amount that a provider charges for a given service. Note that this amount does not usually equal the allowable amount for the same service. See also: allowable amount.
	charge entry batch	An athenahealth term. Allows a user to enter a set of claims in batch, and to default the patient department, facility, supervising provider, provider, service date, and note. Charge entry batches enable a practice to balance against the number of claims and number of charges in a batch.
	chart abstraction	Chart abstraction refers to data conversion from a paper-based medical chart to an electronic medical record (EMR) format. athenahealth offers a chart abstraction service as part of the athenaClinicals solution.
	claim advice	An athenahealth term. A type of claim rule. Like other claim rules, the advice assigns an appropriate hold status to the claim and displays a claim note describing how to correct the claim. The advice also provides an override link, which allows you to override the advice without editing the claim.
	claim alarm	An athenahealth term. A claim alarm is the mechanism athenaOne uses to track and manage outstanding claims. Claim alarms are designed to prevent loss of revenue due to a missed filing deadline. There are two types of claim alarms: ATHENADROP and FOLLOWUP. The FOLLOWUP alarm is used only for athenaCollector clients. It changes the status of claim from BILLED to FOLLOWUP, so that staff are alerted that no remittance has been received within the expected response time period, and the claim needs follow-up action. The ATHENADROP alarm is used when a claim has not been submitted to the payer at all, because it has remained in a hold status for a long period. The ATHENADROP alarm changes the claim status from any kind of hold status to ATHENDROP in the event that the claim is in danger of missing the filing deadline. Once the claim is submitted, the claim status is automatically returned to the previous hold status.
	claim note	An athenahealth term. Claim notes track follow-up actions performed for each claim and often indicate the appropriate corrective action. Claim notes appear under the Claim Notes section of the Claim Edit, Claim Action, and View Claim History pages. A claim note may be text auto-generated by the athenaOne system when a kick reason is selected on the Claim Edit page or the Claim Action page, or it may be text entered by a user in the Note field on the Charge Entry, Claim Edit, or Claim Action page. A user can enter a claim note to document a change of claim status, describe the reason for an action taken on the claim, or to relay a question or comment to athenahealth or to practice staff members.
	claim rule	An athenahealth term. A logic check used by athenaOne to identify many types of claim errors, such as missing information and data format errors. Claim rules come from the athenaOne Rules Engine. When you submit a claim in athenaOne, the claim must pass all claim rules before athenaOne assigns it DROP status. See also: Rules Engine
	clearinghouse	A business entity that transfers or moves electronic claim transactions for a provider/supplier to various payers, including Medicare.
	CLIA	Stands for Clinical Laboratory Improvement Amendments. CLIA oversees and certifies medical laboratories to bill for tests they perform. A department CLIA number is required when billing Medicare for some labs.
	click wrap event	An athenahealth term. Also called the "license agreement pop-up." This pop-up appears when a user logs in for the first time ever and is asked to read and agree to the athenaOne license agreement.
	click-wrap	The textual agreement that is displayed in athenaOne the first time that you log in. Click-wrap indicates that users acknowledge that athenaOne is protected by the contract between their employer and athenahealth.
	clinical guideline	athenaClinicals term. A clinical guideline is a special kind of rule that produces an actionable message in the Clinical Guidelines section. The guideline message alerts providers when there are opportunities for preventive care, such as immunizations (for example. MMR, DPT, Varicella) and tests (mammograms, colonoscopies, cholesterol levels, etc.). The athenahealth clinical guidelines are based on information from agencies such as the Center for Disease Control (CDC), the Advisory Committee on Immunization Practices (ACIP), and other published guidelines for preventive care (such as immunizations and tests).
	Clinical Information System (CIS)	A healthcare industry term. An information system designed for the care delivery process, that captures, and stores clinical care information, and makes that information available to authorized persons for supporting care. This includes clinical diagnostic results and clinical documentation, including nursing notes, progress notes, vital signs and intake and output. It also can include clinical alerts and reminders.
	CMN	Stands for Certificate of Medical Necessity. Medicare sometimes requires a CMN from a DMRC when the claim includes durable medical equipment.
	CMS	The Center for Medicare and Medicaid Services (formerly known as HCFA). This government agency directs and oversees the Medicare and Medicaid programs (Titles XVIII and XIX of the Social Security Act).
	CMS-1491	This paper claim form is used only by ambulance suppliers.
	CMS-1500 Form	A paper form used by providers to file insurance claims for medical services. Formerly known as the HCFA-1500 Form.
	copay	A fixed sum of money to be paid by the patient to the provider for a covered service (for example, an office visit or emergency room visit), typically $5-$20. The copay amount usually appears on the front of the patient's insurance card.
	COB	Stands for coordination of benefits. Refers to the process of determining payers' financial responsibility for a medical claim whenever two or more payers share financial responsibility for the charges on the claim. Includes determining which payer will pay first if two payers cover the same benefits. If one of the payers is Medicare, Federal law may decide who pays first.
	COBRA	Stands for Consolidated Omnibus Budget Reconciliation Act of 1986. A federal law giving 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 (typically 18 months) under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.
	code set	A set of data values that are allowed for a particular field; usually refers to a specific group of CPT codes, ICD-9 codes, or HCPC codes.
	Codesource	See athenaCodesource
	coding	Entering the associated procedure and diagnosis codes for each service and condition that is indicated by a provider on an encounter form or billing slip.
	coinsurance (co-insurance)	An alternative to a copayment, coinsurance is a fixed percentage or amount paid by the insured person for covered medical services. For example, in an 80%/20% coinsurance scenario, 80% of the provider's charge is reimbursed by the payer and 20% of the provider's charge is the responsibility of the insured.
	collection agency	A business that acts as an agent to collect money for unpaid bills.
	common patient index	An athenahealth term. The CPI is a database that contains patient registration information for all patients registered in any provider group within an athenaEnterprise organization. The CPI is available only for athenaEnterprise organizations. Practice settings control which fields are shared (synchronized data across provider groups), as well as the extent to which users can access patient data from other provider groups.
	concurrency	Term used in anesthesia billing. An anesthesiologist may direct the anesthesia services of multiple patients at the same time. The term "concurrency" is used to describe this scenario. Concurrency refers to "the maximum number of procedures that the physician is medically directing within the context of a single procedure and whether those other procedures overlap each other."
	configuration setting	An athenahealth term. Also called practice setting. This is an option switch that controls the behavior of athenaOne for your practice.
	contractual adjustment	Write-off amount equal to the difference between the allowable and the charge amount from the fee schedule. (If the allowable amount is unknown, athenaOne assumes the contractual adjustment is zero.)
	Correct Coding Initiative	Also known as CCI. This initiative is a project developed by the Centers for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies and to eliminate improper coding. CCI uses coding conventions defined in the American Medical Association's Current Procedural Terminology (CPT) Manual, current standards of medical and surgical coding practice, input from specialty societies, and analysis of current coding practice.
	covered lives	Refers to the number of patients served by a provider or practice that has a capitation contract. The number of covered lives is calculated by the third-party administrator (usually an IPA) that administers the capitation contract. Factors include the number of patients seen by the provider and registered patients that match a set of demographics (for example, women for an OB).
	CPI	An athenahealth term. Stands for common patient index. The CPI is a database that contains patient registration information for all patients registered in any provider group within an athenaEnterprise organization. The CPI is available only for athenaEnterprise organizations. Practice settings control which fields are shared (synchronized data across provider groups), as well as the extent to which users can access patient data from other provider groups.
	CPR	Stands for Clinician Performance Review. This athenahealth report is accessible on athenahealth network via the Performance Review link. To see the CPR reports for your practice, from the athenahealth home page, click the Performance Review link at the top right, and then scroll down to the Clinician Performance Review section at the bottom of the page.
	CPR (cardio-pulmonary resuscitation)	CPR stands for cardio-pulmonary resuscitation, a first-aid procedure used to restore breathing and heartbeat. Sometimes called "mouth-to-mouth" resuscitation.
	CPR Report	An athenahealth term. CPR stands for Clinician Performance Review. This report is found on athenahealth network under the Performance Reviews link.
	CPT	Stands for Current Procedural Terminology; a system for billing of healthcare services by assigning a five-digit code to each procedure or service provided. As opposed to the ICD-9 or ICD-10 system which classifies the disease, injury, mortality, and illness (diagnosis), this system classifies the procedure or service provided.
	credentialing	The process of research and examination of a healthcare professional's credentials, practice history and medical certification or license. The credentialing process may include a review of registration, certification, licensure, professional association membership, or the award of a degree in the field.
	CRNA	Stands for certified registered nurse anesthetist
	crossover codes	Codes used by the primary payer to route a claim to a secondary payer. The majority of crossover codes in use today are Medigap codes. Each Medicare carrier assigns its own Medigap code to each Medigap plan. The crossover code populates the Other Payer Secondary ID field (NM109, Loop 2330B) in the ANSI 837. If no code exists, then typically "None" will be printed in this field instead.
	crosswalk	A table that shows the relationship of codes between code sets, for example, a list of diagnosis codes that are permissible to use with a given CPT code. Medicare publishes crosswalk lists for use on the federal level. Local Medicare carriers (LMRP) publish their own crosswalk lists. These lists may be a subset of the federal (Medicare) list, or they may differ from the codes on the federal list. See also: NCD.
	CSI	CSI is the ANSI-standard 276/277 transaction that searches the payer's claims database to pinpoint exactly where a claim is in the payer's adjudication system. For payers using CSI, automated CSI transactions eliminate the need for calls to check on claims that are still in process or that have recently been paid. athenahealth offers CSI as part of our athenaOne service solution. CSI returns claim-level code and charge-level parsing of code and payment information which appears in the Claim Status Inquiry section at the bottom of the Claim Edit page, for claims that have CSI transactions with charge-level data in the inquiry response.
	DAR	Stands for days in A/R. This metric represents an estimate of the average time it takes a medical practice to receive payment for a claim. athenahealth calculates this metric in the following manner: First, for each of the last 7 days of the month, the following algorithm is applied: AR divided by (average charges for last 60 days). Next, the average of the above 7 days' results is calculated to produce the DAR.
	Days in A/R	This metric represents an estimate of the average time it takes a medical practice to receive payment for a claim. athenahealth calculates this metric in the following manner: First, for each of the last 7 days of the month, the following algorithm is applied: AR divided by (average charges for last 60 days). Next, the average of the above 7 days' results is calculated to produce the DAR.
	DBMS	Stands for database management system. A DMBS is software that is used to create and manage a relational database. Athenahealth uses the Oracle DBMS for all client databases.
	DEA	Stands for Drug Enforcement Agency; a federal agency that controls narcotics and other drugs which can be abused.
	deductible	The amount of money the patient must pay each year to cover medical expenses before the insurance policy begins to pay benefits. The deductible amount may be calculated per person or per family.
	default	The value automatically provided by the computer application (such as athenaOne) when no value is entered or selected manually by the user.
	denial code	An athenahealth term. A code (usually with an associated message) that explains why a payer refuses to remit for an item on a submitted claim. A denial code always originates from the payer and appears in an EOB or letter from a payer. Payers may refer to them as denial codes, denial reasons, adjustment codes, adjustment reasons, reason codes, etc. There are approximately 30,000 payer denial codes stored in athenaOne. athenahealth attempts to "map" each payer denial reason to an athenaOne kick reason. See also: kick reason; kick code
	dependent coverage	Insurance coverage for the head of the family that is extended to a spouse or eligible children. Certain age restrictions for children usually apply.
	deposit batch	An athenahealth term. A record of one bank deposit. A deposit batch is composed of one or more payment batches that sum to the deposit batch deposit amount. The deposit amount is the total dollar amount shown on the bank deposit slip, including both checks and cash.
	deposit date	The date that a batch of payments is deposited at a bank.
	DME	Stands for durable medical equipment. DME is medical equipment that is ordered by a doctor for a patient's use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds. DME is paid for under Medicare Part B and Part A for home health services.
	DMERC	Stands for durable medical equipment regional carrier. A DMERC is a private company that contracts with Medicare to pay bills for durable medical equipment.
	DOB	Stands for date of birth.
	DPR	Stands for Drug Price Review, a monthly report that lists the average wholesale prices (AWP) of prescription drugs.
	DRG	Stands for diagnosis-related group. A DRG is a classification scheme used when calculating (a formula by which) the amount of money providers will be paid for various procedures and services, based upon patient study groups classified by age, gender, health condition and predicted treatment needs. This reimbursement methodology is typically used to calculate payment to a hospital for its inpatient services.
	drug formulary	A list of pharmaceutical products and dosages deemed acceptable (most economical and appropriate) by a healthcare organization, used as a prescribing guide or restriction. Also called a formulary.
	E/M coding	E/M stands for evaluation and management coding. The principle E/M coding systems used are diagnosis codes (ICD-9/ICD-10) and procedure codes (CPT-4).
	EFT	Stands for electronic funds transfer. This refers to money transferred electronically from one bank account to another. EFT is used as a replacement for paper checks, because it is more secure and more efficient.
	EIN	Stands for Employer Identification Number. An EIN is a 9-digit number that the IRS assigns in the following format: XX-XXXXXXX. EINs are used by employers, sole proprietors, corporations, partnerships, nonprofit associations, trusts, estates of decedents, government agencies, certain individuals, and other business entities.
	eligibility verification	Notification from the payer that a patient is covered for provider services under an insurance plan. The standard adopted under HIPAA for this transaction type is referred to as the Health Care Eligibility Benefit Inquiry and Response 270/271 ASC X12N 270/271 (004010X092) and was adopted on 10/16/2003.
	EMC receiver	A business entity, such as a payer or clearinghouse, that receives healthcare claims electronically. EMC stands for electronic media claims.
	employee contribution	The portion of health insurance plan premiums paid by an employee to the company's contracted payer.
	EMR	Stands for electronic medical record. Same as CPR (computerized patient record). Note: athenaClinicals is the athenahealth EMR service solution. athenaExchange supports external interfacing with external EMRs.
	enrollment category	An athenahealth term. An enrollment category represents a set of common enrollment needs for medical group enrollment. Because each credentialing entity may have its own set of enrollment needs, each credentialing entity has its own enrollment category in athenaOne. Generally, a 'credentialing entity' is a payer.
	EOB	Stands for explanation of benefits. This is a document that usually accompanies a remittance check from an insurance company. It details each charge on a set of claims, and shows claim numbers, financial information, and/or denial information about the set of claims.
	EPO	A type of preferred provider organization where individual members use particular preferred providers rather than having a choice of a variety of preferred providers. EPOs are characterized by a primary physician who monitors care and makes referrals to a network of providers. People who belong to an EPO must receive their care from affiliated providers; services rendered by unaffiliated providers are not reimbursed.
	ERA	Stands for electronic remittance advice. athenahealth is capable of receiving remittance information from payers electronically, using the ANSI standard format mandated by HIPAA, Health Care Claim Payment/Advice 835 ASC X12N 835 (004010X091A1)
	ERA batch	An ERA batch consists of the payment records in one electronic ANSI 835 file. The total payment amount of an ERA batch is the check or EFT amount as indicated in the 835 file.
	ERISA	Stands for Employee Retirement Income Security Act of 1974. This federal law sets minimum standards for most voluntarily established pension and health plans in private industry, to protect the people who are covered by such plans.
	eSecondary claim	An eSecondary claim is a claim submitted to a secondary payer electronically. Historically, secondary claims have been submitted on paper because payers required the paper EOB to be attached as evidence of the primary payer's payments and adjustments. The new ANSI X12 837 standards, however, provide a way to report this coordination of benefits (COB) information directly in the electronic format, without the need for paper.
	evergreen clause	Health insurance industry term. An evergreen clause is a clause used in an insurance contract stating that the contract shall renew automatically at the end of each term (typically, a term is a year) without either party having to take action to renew.
	FEC	Stands for free-standing emergency center. This is a non-hospital facility equipped to handle medical emergencies.
	fee schedule	A table of procedure codes and their corresponding fees charged by a practice under a contract with a particular insurance package or allowable category. You can manually create fee schedules or provide athenahealth a spreadsheet of procedure codes and fees so that Athenahealth can import the schedule for you.
	fee-for-service	A payment system for healthcare where the provider is paid for each service rendered rather than a pre-negotiated amount for each patient. This is the common payment agreement that applies in PPO health plans. Fee-for-service is also called indemnity.
	FFS	See Fee-for-Service.
	formulary	A list of pharmaceutical products and dosages deemed acceptable (most economical and appropriate) by a healthcare organization, used as a prescribing guide or restriction. Also called drug formulary.
	fraud and abuse	Fraud: To purposely bill for services that were never given or to bill for a service that has a higher reimbursement than the service provided. Abuse: Payment for items or services that are billed by mistake by providers, but should not be paid for by the insurance plan. Fraud is intentional; abuse is unintentional.
	fully worked claim	An athenahealth term. A fully worked claim is one that athenahealth considers uncollectible, even though it remains unpaid. athenahealth tries to contact the payer seven times before considering a charge to be "fully worked." These attempts include, but are not limited to, phone calls, Web portal usage, written demand letters, and claim resubmissions.
	generic drug	A drug which is exactly the same as a brand name drug and is allowed to be produced and marketed after the brand name drug's patent has expired.
	global period	A term used in medical billing. Some healthcare services (for example, maternity) are negotiated so that the fees are all-inclusive (one fee covers a range of services provided for a specific episode or episode of care.) The global period refers to the range of service and time frame covered by the global fee.
	Go-Live	An athenahealth term. The date you first use athenaOne to capture charge-related data. athenahealth does not send claims or patient statements prior to Go-Live.
	GPCI	GPCI stands for Geographic Practice Cost Index (GPCI). Pronounced like "gypsy." The relative values for physician work, practice expense, and malpractice insurance are adjusted for geographic differences between regional and national resource costs.
	GPWW	Stands for group practice without walls. A GPWW is a hybrid between a private practice and an HMO, in which a physician group owns the assets of the collective practices and shares some costs, but each physician controls his/her own patient appointments and staff.
	group number override	An athenahealth term. Occasionally, providers within a medical group have different medical group numbers due to a past merger or restructuring of medical groups. If this is the case, a provider number may be listed with a "medical group override number" to be used on claims in place of the provider's medical group number. A group number override is a property of a provider, not a medical group.
	group practice	Any medical practice with three or more physicians.
	guarantor	The person who authorizes treatment and is responsible for paying the patient's medical charges that are not covered by the patient's insurance plan. Patient statements are sent to the guarantor. For able adults, the patient is usually the guarantor. For minors or incompetent adults, the custodial parent or legal guardian is usually the guarantor. Also called the "responsible party."
	gypsy	see GPCI
	HCFA	Stands for Healthcare Financing Administration. Now referred to as CMS (Center for Medicare and Medicaid Services). The federal agency within the U.S. Department of Health and Human Services that is responsible for administration of Medicare and the federal portion of Medicaid.
	HCFA 1500 Form	A paper form used by providers to file insurance claims for medical services. This form has been officially renamed the CMS-1500 form.
	HCPC Codes	See HCPCS
	HCPCS	Stands for HCFA Common Procedural Coding System. HCPCS includes CPT billing codes, as well as codes for additional services such as ambulance transport, supplies, and equipment. There are three levels of HCPCS codes: Level I codes (CPT codes), Level II codes (national codes), and Level III codes (local codes). Level I (CPT) codes are five-digit numeric codes describing procedures and tests. CPT codes are administered by the AMA with annual updates. Level II (national) codes are five-digit alpha-numeric codes describing pharmaceuticals, supplies, procedures, tests, and services. Level II codes are administered by CMS, and updated quarterly. Level III (local codes) are currently being phased out by fiscal intermediaries.
	Health and Welfare Fund	A healthcare insurance fund that provides and administers benefits to covered union workers and their eligible dependents
	Health Care Eligibility Benefit Inquiry and Response	A standard for eligibility verification adopted under HIPAA, (Health Care Eligibility Benefit Inquiry and Response 270/271 ASC X12N 270/271 (004010X092), adopted on 10/16/2003. See also: eligibility verification
	HIPAA	Stands for the Health Insurance Portability and Accountability Act of 1996. Includes the Final Privacy Rule, which regulates the handling of individually identifiable healthcare information, to safeguard patient privacy.
	HIPC	Stands for Health Insurance Purchasing Cooperative. This is a method of insurance rate-setting and purchasing in which all individuals within a geographic area are considered for purposes of determining insurance rates (based upon a risk pool) which then gives equal purchasing power to both large and small companies.
	HISB	Stands for Healthcare Informatics Standards Board. This is a department within ANSI that works on standards for computer-based patient records, coding, terminology, international data exchange and patient privacy.
	HMO	See managed care
	hospice	A healthcare facility providing medical care and support services such as counseling to terminally ill persons.
	HPI	A healthcare term. Stands for history of present illness.
	HTML	Stands for Hypertext Markup Language. HTML is the basic language used for creating Internet Web pages, understood by Web browsers. Hypertext creates a "clickable" link between one Web page and another.
	HX	A medical shorthand term meaning historical. In athenaClinicals, HX is used to indicate the information represents historical data from sources outside of athenaOne.
	ICD-10 code	A diagnosis code. Stands for International Classification of Diseases, 10th revision. This is a list of codes assigned to various types of illnesses or conditions.
	ICD-9 code	A diagnosis code. Stands for International Classification of Diseases, 9th revision. This is a list of codes assigned to various types of illnesses or conditions. ICD-9 is the standard code set adopted under HIPAA for reporting of diagnosis codes as of 10/16/2003. It is maintained by the U.S. National Center for Health Statistics and is updated annually in October.
	ICF	Stands for intermediate care facility, at which nursing care is provided, with a supervising registered nurse or licensed practical nurse on duty during each daily shift.
	ICN	Stands for internal control number. A number assigned to a patient's bill (or other document) by the insurance company or agent, for internal identification.
	IIHI	Stands for individually identifiable health information (HIPAA term). IIHI includes any information maintained by healthcare providers that could be used to identify an individual. IIHI is protected healthcare information (PHI) under the HIPAA guidelines.
	incomplete medical direction	A term used in anesthesia billing. Incomplete medical direction occurs when the anesthesiologist has not performed all seven specified activities required for recognition by payers. Medical direction is a covered service only if: 1. The physician performs a pre-anesthetic examination and evaluation. 2. The physician prescribes the anesthesia plan. 3. The physician must personally participate in the most demanding procedures of the anesthesia plan, including, if applicable induction and emergence. 4. The physician ensures that a qualified individual performs any procedures in the anesthesia plan that he or she does not perform. 5. The physician monitors the course of anesthesia administration at frequent intervals. 6. The physician remains physically present and available for immediate diagnosis and treatment or emergencies. 7. The physician provides indicated post-anesthesia care.
	indemnity	See fee-for-service
	insurance package	For athenahealth, "insurance package" is any combination of payer, provider network, or insurance product information required to submit medical claims or invoices for adjudication. The "insurance package" is the unit of information stored in athenaOne that allows our clients to assign patients to a set of information that describes how and when claims associated with each patient will be submitted. For example, an insurance package may include the following information: claim mailing address; payer contact information; payer or clearinghouse rules; claim and eligibility routing information; claim and follow-up alarms; and specific claim codes. An insurance package may also allow athenahealth to provide client-specific service functions. For example, an insurance package may allow claims to be held for review; specific reporting functions to be run; and sliding scale fee situations to be set. Insurance package creation, maintenance, and change order processing falls under the jurisdiction of the athenahealth Insurance Package Team.
	interface	A computer term. An interface is a connection to an outside system or data source through which electronic data is transferred from one network or computer system to another.
	IPA	Stands for independent practice association or independent physicians association. This is a type of HMO that contracts with a group of physicians for services to its members, allowing physicians to keep their own private practices and work for more than one HMO.
	IRC	An athenahealth term. Stands for insurance reporting category. athenahealth assigns a reporting category to each insurance plan maintained in athenaOne. This IRC is used to group or categorize packages for the purposes of managing system behavior and reporting.
	JCAHO	Stands for Joint Commission on Accreditation of Health Care Organizations. This is an independent non-profit group that accredits healthcare organizations and monitors quality of care provided.
	jotter	An athenaClinicals term. An athenaOne feature that allows users to use a stylus to "write" on the computer screen.
	keypad	An athenahealth term. A tool that allows users to use a stylus to select letters on the computer screen instead of typing on a physical keyboard.
	kick code	An athenahealth term. A unique alphabetic code that identifies a kick reason. athenahealth uses kick codes to categorize payer denial reasons and to initiate claim actions. There are approximately 300 unique kick codes in athenaOne. See also: kick reason; payer denial reason
	kick reason	An athenahealth term. A kick reason describes why a claim has not yet been paid, or communicates the reason for a change in the status of an unpaid claim. It appears in the Claim Notes section of claim-related athenaOne pages. A kick reason may originate as a payer denial reason (from an EOB) that is then mapped to an athenaOne kick code. Both athenahealth staff and athenaOne users in a client practice can enter kick reasons for a claim. Entering a kick reason may result in a change to the claim status. Every kick reason is identified by a unique alphabetic code called a kick code. See also: kick code; payer denial reason
	late charge	In athenaOne, a charge whose post date is in the month following the month of its service date (or any subsequent month following the service date). A charge is considered late even if the service was at the very end of a month and the post date is at the beginning of the next month.
	LMRP	Stands for Local Medical Review Policy. LMRP's are developed by Medicare contractors to explain when an item or service will be considered covered (including when it is "reasonable and necessary") and how it should be coded
	lockbox	A post office box address used as the pay-to address for a medical practice remittances by mail or electronic transfer, or both. Banks may offer a lockbox service for a fee, whereby the bank provides the post office box address, processes the remittance payments several times a day, deposits them into the medical practice's account, forwards the remittances and correspondence to athenahealth, and notifies the practice of the deposit. See also: athenaMailbox
	LPN	Stands for licensed practical nurse. A graduate of an accredited school of practical nursing and whose qualifications have been examined by a state board of nursing, and who has been legally authorized to practice as a licensed practical nurse.
	LVN	Stands for licensed vocational nurse. A graduate of an accredited school of vocational nursing and whose qualifications have been examined by a state board of nursing, and who has been legally authorized to practice as a licensed vocational nurse.
	magic word	An athenahealth term. Magic words are special athenaOne keywords that can be used in creating templates for billing slips, forms, and documents of type HTML. Magic words are automatically replaced by live data elements when the document is generated. For example, PATIENTNAME is replaced by the name of the patient for which the form is generated. See also: Billing Slips.
	Main Menu	An athenahealth term. The dark purple bar across the top of your screen. The Main Menu provides first-level navigation links.
	managed care	A system of health insurance that stresses preventive measures and provides incentives for patients to maintain good health -- for example, discounts for health club memberships, discounts for non-smokers, and so forth. Managed care is also characterized by limiting the patient's choice of doctors and hospitals to an approved network of providers, and by requiring referrals to see specialists and receive other non-routine care. HMOs and PPOs are the most common types of managed care coverage.
	MEDCIN	MEDCIN is a third-party product developed by Medicomp, Inc., that athenahealth has licensed for athenaClinicals. MEDCIN is an industry-accepted medical knowledge engine that consists of 280,000+ clinical concepts, each with unique IDs. These clinical concepts are organized into six basic concept types: Symptoms, History, Physical Exam, Tests, Diagnoses, and Therapy. MEDCIN uses information provided to its APIs to recommend an E&M billing code for a patient visit.
	medically necessary	A service or treatment that is absolutely necessary in treating a patient and the denial of which could adversely affect the patient's health. See also: CMN
	Medicare Part A	Usually referred to as Hospital Insurance, it helps pay for inpatient care in hospitals and hospices, as well as some skilled nursing costs.
	Medicare Part B	Helps pay for doctor services, outpatient care, and other medical services not paid for by Medicare Part A
	Medicare Risk Contract	A contract program where patients pay a flat fee to Medicare (rather than a premium) which then assumes responsibility for delivering healthcare through its qualified providers.
	Medigap	Medicare supplemental insurance that pays for some services not covered by Medicare Part A or Part B, including deductible and coinsurance amounts.
	member physician	A physician who has signed a contract with a health plan or managed care organization to provide care for its members and receive reimbursement.
	MIB	Stands for Medical Information Bureau. This is a data pool service that stores coded information on health histories of persons who have applied for insurance from subscribing companies.
	modifiers	See: procedure code modifiers.
	MQSA	Mammography Quality Standards Reauthorization Act
	MRI	Stands for magnetic resonance imaging. Technology that shows the differences between soft tissue structures that cannot be demonstrated with x-ray technologies.
	MSO	Stands for management services organization, an organization that provides practice management services to physicians groups and hospitals, controlling the business assets of the group it services.
	MSP claims	Medicare Secondary Payer (MSP) claims are claims where Medicare is the secondary payer. Medicare may be secondary for claims involving Black Lung, ESRD, Worker's Comp, and so forth. MSP claims have different requirements from other claims when submitted electronically. See also: eSecondary claim
	MVA	Stands for motor vehicle accident (insurance reporting category used for case policy insurance packages).
	MX Engine	Stands for athenaOne Message Exchange Interface Engine. This athenahealth technology is used for athenaExchange, our external file interface service.
	NCD	Stands for National Crosswalk Database. A crosswalk is a list of diagnosis codes that are permissible to use with a given CPT code. See also: crosswalk.
	NDC	Stands for National Drug Code. Many Medicaid payers require NDC information on claims with J drug procedure codes. As you enter claims, athenaOne will alert you when this information is required. athenaOne supports an NDC service type add-on for capturing NDC numbers at charge entry.
	NLM	Stands for the National Library of Medicine. This is a branch of the National Institutes of Health which contains a library of greater than five million documents and sponsors fellowships and grants for healthcare research and training.
	NPI	Stands for National Provider Identifier, the HIPAA provider identification system. NPI numbers replaced provider numbers after 2007.
	NSC	National supplier clearinghouse. The NSC is the CMS-approved (Center for Medicare/Medicaid Services) organization that administers all provider/supplier number authorizations, account updates and other account maintenance/oversight.
	NSF	Stands for National Standard Format and nonsufficient funds. National Standard Format (NSF) is a standard electronic Medicare-approved claim form. This claim form format has a set 320-byte record. If you use this format, you must transmit the entire 320-byte format, even if the data keyed does not occupy all 320 bytes. Nonsufficient funds (NSF) refers to the status of a checking account that does not have enough money to cover a transaction. NSF can refer to the fee charged when a check is presented but cannot be covered by the balance in the account.
	OB episode	An athenahealth term. An OB episode is a mechanism to track OB enrollments and information about clinical outcomes. Enrollment, EDD, and Delivery reports organize information captured in the OB episode. Once saved, OB episode information is available for reporting. You should create the episode at the initial visit and continue to update the episode record as the pregnancy progresses. The OB Episode page is accessible if your practice has the OB practice setting enabled.
	OSHA	Stands for Occupational Safety and Health Administration. This is the federal agency that is responsible for enforcement of industrial health and safety regulations.
	overpayment	Occurs when a payer remits an amount greater than the outstanding balance due.
	palliative care	Treatment that increases patient comfort and improves the quality of life during the last phase of a patient's life. Palliative care uses the principles of hospice and applies them to care to patients who are in an earlier stage of their illness than hospice patients. Unlike hospice care, no specific therapy is excluded from consideration. Palliative care often segues into hospice care as the illness progresses.
	patient account alarm	An athenahealth term. See patient account alarm types
	patient account alarm types	An athenahealth term. Alarm types are used for self-pay account management. If you use this functionality in your practice, you should set up an alarm for every dunning level. Once you have created the patient account alarms, you can create customized worklists to divide and assign self-pay accounts for follow-up using the Self-Pay Account Worklist page. When a patient's self-pay account appears on a worklist, your staff can then take appropriate action on the account using the Patient Account View page.
	Patient Actions Bar	An athenahealth term.The Patient Actions Bar is a navigation feature located near the top of the Quickview page and some other patient-specific pages. It provides quick access to patient-specific pages and actions in athenaOne. You can access the Patient Actions Bar menu from any page in athenaOne using the backslash ("\") key, as long as a valid patient ID appears in the Find patient tool.
	payer	The insurance company, organization, or individual who remits payment for medical services.
	payer denial message	See denial code
	payment batch	An athenahealth term. A set of posting transactions. Payment batches are created as components of a deposit batch (see Manage Deposit Batches.) Generally, a payment batch corresponds to one EOB remittance check covering multiple charges, however, two or more smaller remittance checks can also be grouped together into one payment batch. A time-of-service payment batch is used to record over-the-counter and petty cash transactions. A zero-dollar payment batch is used to record transactions that have no net effect (for example, converting an unpostable record to a payment)
	Payment Batch Creator	An athenahealth term. The Payment Batch Creator (PBC) is an important tool in the athenahealth remittance processing workflow. PBC users can efficiently review and sort images to identify and process remittance documents produced by ERA payers.
	PBC	An athenahealth term. The PBC is the Payment Batch Creator, the application that athenahealth uses to split payment batches for processing. PBC users can efficiently review and sort images to identify and process remittance documents produced by ERA payers.
	PCL	Stands for Printer Control Language. PCL allows athenaOne to "talk" directly to a printer to control where an image begins to print on a page.
	permission	See: user permission
	PHI	Stands for protected health information (HIPAA term). This patient information is covered under the HIPAA Privacy Rule. See also: IIHI (individually identifiable health information).
	physical status codeset	Simple taxonomic guide for assessing coexisting disease to indicate the patient's overall preoperative physical health. Used in anesthesia claims.
	PMH	Stands for previous medical history.
	PMPM	Stands for "per member per month" - term used in describing amounts for capitation reimbursement.
	PNC	An athenahealth term. Stands for provider number category. A set of insurance packages that use the same provider number.
	Point-of-Service Plan (POS)	A type of insurance plan that allows patients to choose doctors and hospitals without having to first get a referral from their primary care physician.
	post date	The date a transaction is recorded in athenaOne; in other words, it's the general-ledger reporting date in athenaOne. An athenaOne user can specify the post date when the transaction is created, but cannot update the post date after the transaction has been created.
	posting	Posting is the process in which payments, denials, adjustments, and transfers are applied to client accounts in athenaOne, according to EOBs received from payers. For athenaCollector clients, posting is the responsibility of athenahealth.
	PPO	Stands for Preferred Provider Organization, or Physician Practice Organization. This is a managed care organization similar to an HMO except that physicians are typically paid for services provided and patients may opt to use non-network physicians.
	PQRS	Physician Quality Reporting System. Superseded by MIPS. Under the Tax Relief and Health Care Act of 2006 (TRHCA), Section 101 under Title I authorizes the establishment of a physician quality reporting system by the Centers for Medicare and Medicaid Services (CMS). CMS has titled the statutory program the Physician Quality Reporting System (PQRS). Formerly, PQRI.
	practice setting	An athenahealth term. A programmatic "switch" in the athenaOne system that controls the behavior of athenaOne for your practice. Practice settings are used to enable functionality and to specify variables such as dates, minimum and maximum thresholds, available claim formats, and so on. Only authorized athenahealth staff members can access practice settings.
	preadmission approval	An agreement by the insurance company to pay for a patient's medical treatment while admitted to a hospital. Hospitals ask the insurance company for this approval before providing medical treatment.
	preadmission certification	See: pre-admission approval
	preauthorization	See: pre-admission approval
	precertification	See: pre-admission approval
	preadmission review	see pre-admission approval
	predictive rule	An athenahealth term. A kind of claim advice which uses historical data in athenaOne to predict likely denials based on actual claim experience of our clients. Predictive rules currently include Medical Necessity Denials and Benefits Coverage Denials.
	preferred provider organization (PPO)	A network of healthcare providers that have agreed to provide medical services to a health plan's members at discounted costs. PPO members typically make their own decisions about their healthcare rather than going through a primary care physician like HMO member. The cost to use physicians within the PPO network is less than using a non-network provider.
	prepayment plan	An athenaOne feature. Similar to a payment plan, a prepayment plan allows the practice to collect regular payments from a patient in advance of expected services, and to reserve these funds to defer the cost of the specified services.
	prevailing charge	An amount that represents the amount commonly charged for a service by providers in a specific region or community. Your insurance company determines this charge.
	Primary Care Network (PCN)	A group of doctors serving as primary care physicians.
	primary care physician	Under an HMO or Point-of-Service (POS) plan, a primary care physician is usually your first contact for healthcare. The PCP is usually a general practitioner, family practitioner, internal medicine practitioner, or pediatrician. The primary care physician makes referrals to specialists when medically necessary.
	procedure code modifier	Two-digit code added to a CPT code (separated by a comma) that further qualifies the code (for example, 99215,25). Coding modifiers appear on the claim and affect claim adjudication; non-printing modifiers are used by the practice for internal tracking purposes and do not appear on the claim form or affect claim adjudication.
	progress note	A document, written by the clinician or provider, that describes the details of a patient's encounter. Also called a chart note.
	provider	An individual or institution that provides medical care. Providers can be medical doctors, nurses, physical therapists, clinics, medical groups, and so forth. In athenaOne, the term denotes individuals such as doctors, nurses, and physical therapists, but not institutions.
	provider group	An athenahealth term. A provider group is a set of providers, often in the same specialty, who work at the same location and share all financial information. For non-athenaEnterprise practices, provider groups are used for reporting only. See the "athenaEnterprise and Patient Privacy" topic for more information about provider groups and athenaEnterprise.
	Provider Group Enterprise practice	An athenahealth term. A practice configured with the athenaEnterprise overlay, and with practice provider group-based data permissions enabled. Patient statements are issued for each provider group separately.
	provider number category	An athenahealth term. A set of insurance packages that use the same provider number.
	reference name	An athenahealth term. A short, one-line name for the address in the Pay-To Address menu on the Medical Groups page and on the Medical Group Enrollment page, so that you can distinguish between address selections.
	referral	An official documented process that authorizes an insured patient to get care from a specialist or hospital. This referral usually comes from the primary care physician. See also: authorization
	referral number	A number that indicates an insured patient is authorized to get care from a specialist or hospital. This referral usually comes from the primary care physician.
	relational database	A means of computerized data storage that consists of a collection of tables with columns that "relate" to each other using primary key and foreign key columns. This organization enables users to access, report on, and update every data item stored in the database. See also: table; DBMS
	reporting name	An athenahealth term. This is a provider's a second username. A provider may have two different athenaOne usernames for scheduling or credentialing purposes. The second username (the reporting name) is used by the A/R Aging Report Wizard and Activity Report Wizard to combine data from two usernames under a single username (for reporting purposes only).
	repricer	A person, an organization, or a software package that reviews procedures, diagnoses, fee schedules, and other data and determines the eligible amount for a given healthcare service or supply.
	responsible party	See: guarantor
	revenue code	A code used to identify a specific room, service (X-ray, laboratory), or billing sum for billing purposes. Revenue codes are reported when submitting claims using the UB-04 (CMS-1450) format or electronic equivalent (such as 837I).
	rider	A document which amends a policy or certificate. It may increase or decrease benefits, waive the condition of coverage or in any other way amend the original contract.
	RoB	An athenahealth term. An RoB is an HTML page or pages displaying ERA data in a Medicare EOB type format. The athenaOne system displays RoBs by default instead of the scanned image when the payment batch route on a payment batch has the "paperless" flag enabled.
	role	An athenahealth term. A set of authorized athenaOne functions, or "user permissions." Roles are used to control user access in athenaOne. The athenaOne system administrator in your practice has the ability to grant and revoke the user permissions and roles associated with your user account.
	RPh	Stands for registered pharmacist.
	RTA	An athenahealth term. Stands for real-time adjudication. RTA sends claim information to the payer electronically and returns a response with information about payment of the claim. This functionality is designed to improve time of service payment collections, as well as shorten the overall claim cycle by identifying denial issues sooner.
	Rules Engine	athenahealth term. Our proprietary Rules Engine stores all requirements for claim submission, including the standard, ANSI-required format rules and payer-specific validation rules. athenaOne uses the Rules Engine to create "clean" claims. The Rules Engine database is actively maintained by athenahealth professionals (the Rules Team) who conduct ongoing research to create new rules and retire old ones to ensure that the database content is as current and comprehensive as possible. See also: claim rule
	RVU	Stands for relative value unit. An RVU is one of the three components used when adjudicating a claim using the Resource-Based Relative Value Scale (RBRVS) payment methodology. Medicare uses three kinds of RVU: Work RVU (provider work), Facilities RVU (provider expenses), and Malpractice RVU (provider malpractice insurance).
	scheduling resource type	An athenahealth term. A scheduling resource type represents a set of providers or resources that, for scheduling purposes, are interchangeable. Scheduling resource type are used for multi-resource scheduling.
	scrub	See: claim rule
	secondary insurance policy	A second insurance policy that may pay some charges not paid by the primary insurance company. Whether payment is made depends on the insurance benefits, the coverage, and the benefit coordination. Payment checks from secondary insurance payers may be sent directly to the patient.
	Sequel	The language that is used to communicate with a relational database. The correct term for this language is SQL, or Structured Query Language.
	shared TIN	An athenahealth term. Refers to athenaCollector practices sharing a tax identification number (TIN) with other entities (such as another practice or hospital).
	sliding scale cash plan	This is a special kind of self-pay cash payment plan designed for patients who qualify as indigent. With this type of plan, the patient pays either a small flat fee, or a small percentage of the fee, or nothing at all. athenaOne creates an automatic adjustment for the difference between the amount of patient responsibility and the charge. No claim is created because there is no payer other than the patient.
	SNF	Stands for skilled nursing facility. This is a facility that provides 24 x 7 medical care with at least one registered nurse scheduled for each day shift.
	SOAP	General medical acronym used to describe the basic stages for a patient encounter. Stands for "subjective, objective, assessment, plan."
	SQL	Stands for Structured Query Language. The SQL language is used to communicate with a relational database. SQL is sometimes pronounced "sequel."
	standard payment batch	An athenahealth term. This is a non-time-of-service batch that is used to post payments covered by a check that accompanies an EOB.
	stock and flow reports	In athenaOne, there are two types of Deposit Wizard reports: "stock" and "flow." The stock report shows the current state of every deposit, with the transactions it contains. Run retrospectively, it shows what that state was on a prior date. The flow report shows what changed about deposit batches during a time period.
	supplemental insurance coverage	An additional insurance policy that handles claims for deductibles and coinsurance reimbursement. Medigap is an example of supplemental insurance coverage.
	table	A table is a computerized data storage area that is organized into rows and columns. A table may have many columns (even hundreds), and any number or rows (even millions). See also: relational database
	tablespace	A tablespace is a term used in database technology. A tablespace is a container for tables. It controls access to the tables. In athenaOne, a tablespace is used as an exclusive data storage area containing the tables of a single client practice. This allows athenahealth to keep each client's data separate from all other client data, and secure from access by any other client. To access the data in a tablespace, the user must be granted access to that tablespace.
	takeback	Occurs when a payer recovers an overpayment made on a claim. No money is returned by the practice, but the payer records the overpayment as a line item credit on the EOB. A takeback is essentially a reverse payment.
	Task Bar	An athenahealth term. The show-hide area at the left side of your screen, where Today's Appointments and other worklists appear.
	taxonomy code	An industry term. Taxonomy codes allow providers to indicate their specialty category. The standard set of taxonomy codes contains both personal and organizational codes. Personal taxonomy codes are used to classify a medical practitioner's area of specialty. Organizational taxonomy codes are used to classify an institution's facility type. Effective January 1, 2007, institutional Medicare providers who submit claims for their primary facility and its subparts (such as psychiatric unit, rehabilitation unit, etc.) must report a taxonomy code on all Medicare Part A claims submitted to their fiscal Intermediary.
	third party administrator	A company that handles health claims independently of the healthcare organization.
	tickler	Reminder to schedule an appointment for a patient. Appointment ticklers appear on the patient Quickview under the Appointments heading.
	time-of-service batch	An athenahealth term. A time-of-service batch is a payment batch that includes front desk payments (copay, coinsurance, and other patient payments) collected by one staff member in a practice.
	TIN	Stands for tax identification number.
	transaction	Any action in athenaOne that affects financials or financial reporting. For example, credit, debit, and transfer activity.
	TRICARE	New name for the traditional Standard CHAMPUS, the U.S. military's healthcare coverage program. Anyone who is CHAMPUS-eligible can use TRICARE Standard. (Active duty personnel are not CHAMPUS-eligible and are automatically enrolled in TRICARE Prime).
	UB-04	The UB-04 (formerly, UB-92) is a paper claim form used by institutional providers (for example, hospitals, clinics, ASCs) to bill a Medicare Administrative Contractor (MAC). The form is available from the Standard Register Company, Forms Division. The paper UB-04 is also known as Form CMS-1450.
	UCR	Stands for usual, customary, and reasonable. A charge for healthcare that is consistent with the going rate or charge in a certain geographical area for identical or similar services.
	UDRC	Stands for upside down revenue cycle. This is a model for medical billing management in which front-office staff capture vital patient demographic, insurance, and clinical information at the earliest point in the patient appointment process, instead of during the appointment follow up process. athenaOne supports this billing model.
	unapplied balance	An athenahealth term. The credit balance in a patient account, excluding any prepayment balance.
	unpostable	An athenahealth term. (athenahealth is phasing out the term "unpostable record" in favor of "remittance record.") An unpostable is an amount of money that does not appear to be a payment for an athenaOne charge. For example, posters may find a payment that is for services from your legacy system, or that is otherwise unidentifiable. Posters may also encounter entire checks that are not for healthcare services (for example, a tax refund), but that were included in your deposit. Capitation payments are also unpostable amounts because they cannot be applied to specific charges. Unpostables account for these discrepancies and ensure that all money in your deposit batch is fully accounted for.
	UPIN	Stands for Unique Physician Identification Number; a unique ID for each physician who billed services under Medicare, this system was replaced by the National Provider Identifier system developed by CMS. See also: NPI.
	upside down revenue cycle	Also known as UDRC. This is a model for medical billing management in which front-office staff capture vital patient demographic, insurance, and clinical information at the earliest point in the patient appointment process, instead of during the appointment follow up process. athenaOne supports this billing model.
	user permission	An athenahealth term. A system authorization to access data or perform a function in athenaOne. User permissions are bundled together into roles. The athenaOne system administrator in your practice can grant and revoke the user permissions and roles associated with your user account.
	username	An athenahealth term. A username is a unique identifier required for login to athenaOne. A username must be associated with a password. Usernames are generated using the first name initial and the last name of the user. If this designation is not unique, athenaOne automatically appends a digit to the end to render the username unique throughout our entire network.
	usual, customary and reasonable (UCR)	This phrase describes a charge for healthcare that is consistent with the going rate or charge in a certain geographical area for identical or similar services.
	Utilization Review (UR)	Process designed to reduce unnecessary medical services, both inpatient and outpatient. Utilization reviews may be prospective, retrospective, concurrent, or in relation to discharge planning.
	VNA	Stands for Visiting Nurse Association.
	waved appointment slots	An athenahealth term. Waved appointment slots are multiple appointment slots that appear in one provider's schedule for the same time period. In other words, two or more appointment slots may appear in the 2pm-2:15pm time period on the same day.
	withhold	The portion of a claim deducted and held by a health plan before payment is made to a capitated physician. A form of compensation whereby a health plan withholds payment to a provider until the end of a period at which time the plan distributes any surplus based on some measure of provider efficiency or performance.
	Workers' comp	Workers' Comp (or Workers' Compensation) refers to laws designed to ensure that employees who are injured or disabled on the job are provided with fixed monetary awards, without having to sue for damages. State Workers' Comp laws establish this framework for most employment. The details differ from state to state. There is also a federal workers' comp law that covers federal employees or those workers employed in some significant aspect of interstate commerce.
	workflow	The ordered processes and sequence of steps needed to accomplish specific tasks.
	worklist	An athenahealth term. A queue of work items that need user action to resolve. The most common worklists contain links to claims, but others contain links to items such as missing slips, appointments, and patients.
	Workspace	An athenahealth term. The large area on right side of your screen where athenaOne pages appear.
	XML	Stands for Extensible Markup Language. An extension of HTML designed to improve the functionality of the Web by providing more flexible and adaptable information identification. For example, the contents of a Web page written using XML can be sorted dynamically, but a Web page using only HTML cannot.
	OB Episode Form	An athenahealth term. Similar to the ACOG Antepartum Record. Used to convey standard antepartum information to the hospital of delivery.
	continuity of care document	A healthcare industry term. Continuity of Care Documents are becoming a standard format for delivering a summary of care from one provider or establishment to another.
	corporate billing	A healthcare industry term. Corporate billing is a contract between a corporation, a non-health insurance company, and a physician to pay for non-workers compensation healthcare claims, for example, physicals, drug screening, etc. Checks for corporate bills come with a monthly invoice instead of an EOB.
	appointment reminder	An athenahealth term. An outbound phone call to a patient, reminding the patient of an upcoming appointment. Appointment reminders are administered in athenaOne using the ReminderCall service.
	appointment tickler	An athenahealth term. A user-created message to remind practice staff to schedule a patient appointment. Appointment ticklers can be created from the Quickview or Checkout page, the RTO encounter section, and other athenaOne locations.
	ASTC	An athenahealth term. Stands for Allowable Schedule Terms and Conditions. See also: Payment Yield.
	EDD	Stands for estimated delivery date. Used in OB episode tracking.
	EHR	Stands for electronic health record. Synonym for EMR, electronic medical record.
	front-end rejection code	An athenahealth term. A code used by a payer to indicate the reason why the payer rejected a submitted claim. Front-end rejection codes are mapped to athenaOne kick codes by means of the file source and kick reason category.
	FQHC (Federally Qualified Health Center)	The FQHC benefit under Medicare was added effective October 1, 1991, when Section 1861(aa) of the Social Security Act (the Act) was amended by Section 4161 of the Omnibus Budget Reconciliation Act of 1990. FQHCs are "safety net" providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless. The main purpose of the FQHC Program is to enhance the provision of primary care services in underserved urban and rural communities. See also: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf
	task assignment override (TAO)	An athenahealth term. A task assignment override allows the provider or provider staff to override the default task assignment for a document classification, orders, and patient cases in the Clinical Inbox.
	TAO	Stands for task assignment override. An athenahealth term. A task assignment override allows the provider or provider staff to override the default task assignment for a document classification, orders, and patient cases in the Clinical Inbox.
	accelerator	A software tool or feature designed to provide a faster online experience. Examples include keyboard keystroke combination, programmable function keys, pre-populated input fields, auto-completion of input fields, and selection lists that provide most-used options at the top.
	SNOMED-CT	Stands for Systematized Nomenclature of Medicine - Clinical Terminology. A standard set of clinically oriented medical terminology that is widely used in healthcare. SNOMED-CT provides the core general terminology for the electronic health record (EHR).
	ICD-10	The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. CMS updates ICD-10 codes annually, removing certain codes and adding more specific replacements. Because athenaOne removes expired ICD-10 codes from order sets and encounter plans, providers must select a new ICD-10 code when using these order sets and encounter plans. The practice can update order sets and encounter plans to use the new, more specific ICD-10 codes.
	Marketplace (MDP)	athenahealth has an online Marketplace website (the URL is https://marketplace.athenahealth.com/) where healthcare provider organizations and physician practices can browse and select healthcare IT (HIT) solutions that augment and complement the athenahealth suite of cloud-based services.
	local network	An athenahealth term. A local network is an athenaEnterprise network of clinical providers that is defined by the athenaEnterprise organization. These providers are typically part of a large physician group, affiliated groups of providers, or hospital system. Local network functionality is embedded within the athenaClinicals ordering workflow to visually indicate the in-network status of a receiving clinical provider. You can use network utilization reports to analyze the order flow inside or outside the local network.
	VDT	View, Download, Transmit (VDT) is a CMS quality measure that aims to increase patient involvement in their healthcare by giving patients access to key information in their EHR. However, in cases where "substantial harm may arise from disclosure [of the patient's health information] online," providers can choose not to share certain health information in this manner.
	EPCS	Stands for Electronic Prescribing of Controlled Substances. EPCS is a technology solution that helps address the problem of prescription drug abuse by removing paper prescriptions from the prescribing process. EPCS regulations permit pharmacies to receive, dispense, and archive these electronic prescriptions. Section 2003 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) requires generally that prescriptions for controlled substances covered under a Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug Plan (MA/PD) be transmitted by a health care practitioner electronically in accordance with an electronic prescription drug program, beginning January 1, 2021.
	Sig field	The Sig field is intended to provide the patient with complete, unambiguous instructions for the use of the prescribed medication, including the correct dosing. The directions for use of the medication should not be split between the Sig and Notes fields. If you include directions for use in the Notes field, pharmacy staff may miss critical information that needs to be transmitted to the patient. The information in the Sig field should not conflict with information in the Notes field. Conflicting information will require pharmacists to contact the prescribers to clarify their intent, thereby negating the efficiencies of e-prescribing.
	AOE (ask on order-entry)	Questions specific to an order type, which appear in the order form when the order is added. The questions provide additional information that the receiving facility needs to perform the order. These questions are administered using the AOE Question Management page.
	briefing	A component of the patient encounter, showing important patient information at the start of the Intake and Exam stages.
	MAR	In athenaOne for Hospitals and Healthcare Systems, the electronic Medication Administration Record (MAR) shows the medications a patient receives in the EHR, via either Barcode scanners or manual entry. Medications appear in the MAR once they are entered by a Nurse or Physician, and can be marked as administered before being signed by a physician or verified by a pharmacist.
	Medication Administration Record (MAR)	In athenaOne for Hospitals and Healthcare Systems, the electronic Medication Administration Record (MAR) shows the medications a patient receives in the EHR, via either Barcode scanners or manual entry. Medications appear in the MAR once they are entered by a Nurse or Physician, and can be marked as administered before being signed by a physician or verified by a pharmacist.
	swing bed	A level of care that can "swing" between acute care or extended skilled nursing care, so that the patient can remain in the same facility even if their care needs change (or "swing") from acute care to skilled nursing care.
	PRN	Latin abbreviation for pro re nata, meaning "as needed."
	H&P	A healthcare term used in hospital admissions. Stands for History and Physical
	PACS	Stands for Picture Archiving and Communication System. Used in radiology departments in hospitals and labs. The format for image storage and transfer is DICOM (Digital Imaging and Communications in Medicine).
	DICOM	Stands for Digital Imaging and Communications in Medicine. Standard format for medical imaging. Used for radiography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), etc.
	RIS	Stands for "radiology imaging system." Used by radiology practices for scheduling, resource management, examination performance tracking, examination interpretation, results distribution, and procedure billing.
	CPOE	Stands for "computerized physician order entry." Any electronic order entry system used by physicians to treat patients. The term is used in most hospitals to refer to their electronic order entry system.
	MIPS	Merit-based Incentive Payment System. Replaces PQRS and Quality Portion of the Value Modifier. MIPS is a new program in 2017 that streamlines three independent programs and adds a fourth component to promote ongoing improvement and innovation to clinical activities. MIPS provides clinicians the flexibility to choose the activities and measures that are most meaningful to their practice to demonstrate performance.
	FSA	A flexible spending arrangement (FSA) is a tax-advantaged financial account set up through an employer. An FSA allows an employee to set aside a portion of earnings to pay for qualified expenses. Money deducted from an employee's pay into an FSA is not subject to taxes. One significant disadvantage to using an FSA is that funds not used by the end of the plan year are lost to the employee.
	HRA	A health reimbursement account or health reimbursement arrangement (HRA) is an IRS-sanctioned program that allows an employer to set aside funds to reimburse medical expenses paid by participating employees.
	HSA	A health spending account (HSA) is a tax-advantaged medical savings account available to individuals who are enrolled in a high-deductible health plan. The funds contributed to an HSA are not subject to federal income tax at the time of deposit. Unlike an FSA, unspent funds roll over and accumulate year to year. HSAs are owned by the individual.
	scribe	A scribe is an unlicensed person hired to enter information into the electronic medical record (EMR) or chart at the direction of a physician or practitioner. A scribe's core responsibility is to capture accurate and detailed documentation of the encounter. A scribe can work on site or remotely from a HIPAA-secure facility. Scribes are not permitted to make independent decisions or translations while capturing or entering information into the health record or EHR beyond what is directed by the provider. The physician is ultimately accountable for the documentation and should sign and note that the scribe's entry accurately reflects the work done by the physician.
	UDI	Stands for unique device identifier. Used to identify medical implant devices.
	acuity	The acuteness, or level of severity, of an illness or injury. This is used to prioritize care of patients in an emergency room.
	COT	Stands for clinical order types. These generic orders are used in athenaOne.
	CPOT	Stands for clinical provider order type. CPOTs are orders specific to a particular practice or organization (the clinical provider). A catalog of facility-specific lab or imaging orders is a "compendium." The mapping of CPOTs to the athenahealth global clinical order types (COTs) enables accelerators such as order sets, point-of-care tests, and the automatic tying of results to orders.
	DNFB	Stands for Discharged Not Final Billed - A metric measuring the time between patient discharge and billing for the hospital visit
	athenaFax	The athenaFax service uses the same fax server maintained by athenahealth. You can send outbound clinical documents by athenaFax, including patient charts and records; outbound orders and order renewals; insurance authorizations; and consult and referral letters. athenahealth monitors outbound fax transmission errors and notifies you if we learn that a fax could not be transmitted to the intended recipient. Note: athenahealth limits the chart print (sent via athenaFax) to 40 pages per patient.
	PCA	Stands for patient-controlled analgesia. A form of medication delivery where the patient controls the amount of pain medicine (analgesia) received.
	Developer Portal	An athenahealth website that showcases network endpoints and other integration technology that athenahealth supports. The url is: https://www.athenahealth.com/developer-portal
	In-network provider	A provider or facility that has a service agreement in place for, and uses, the athenaOne service.
	Same-day order	Any order that requests service to be provided on the day that the order is entered in the system. Same-day orders must be submitted by 5:00 p.m. EST. All clinical information must be submitted at the time of the request. Patient orders with payers that require more than 24 hours to process will not be completed before the patient's procedure time. Orders should comply with the facility's policies on receiving such orders.
	dual eligible beneficiaries	Patients who are eligible for both Medicare and Medicaid are referred to as "dual eligible beneficiaries." These beneficiaries include people who are enrolled in Medicare Part A and/or Part B and who receive full Medicaid benefits and/or assistance with Medicare premiums or cost sharing through a Medicare Savings Program (MSP). Patients with dual eligible plans have both Medicare and Medicaid benefits through a single commercial plan and have a single member ID to represent both plans.
	EMC	Stands for electronic media claims. A flat file format used to transmit or transport claims.
	Surgical count	The process of counting any item that potentially be retained in a patient during a surgical procedure; an item that potentially be retained in a patient during a surgical procedure.
	LOINC	Stands for Logical Observation Identifiers Names and Codes. LOINC is a common language for identifying health measurements, observations, and documents. LOINC applies universal code names and identifiers to medical terminology related to electronic health records to assist in the electronic exchange and gathering of clinical results (such as laboratory tests, clinical observations, outcomes management, and research). Several standards, such as IHE and HL7, use LOINC to electronically transfer results from different reporting systems to the appropriate healthcare networks.
	HEDIS	Stands for Healthcare Effectiveness Data and Information Set. HEDIS is a comprehensive set of standardized performance measures used by more than 90% of U.S. health plans to measure performance on important dimensions of care and service and to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. The measures are developed by the National Committee for Quality Assurance (NCQA).
	wrap claim / wrap around claim	Wrap (or wraparound) claims allow athenahealth to bill Medicaid or Medicare to capture the gap payment between the Managed Care Organization (MCO) or Medicare Replacement plan's payment and your per diem rate.
	admixture (IV)	The JCAHO has defined i.v. admixture as "the preparation of pharmaceutical product which requires the measured addition of a medication to a 50 mL or greater bag or bottle of IV fluid." This does not include the drawing up of medications into a syringe, adding medication to a Buretrol or i.v.
	athenaCommunicator	athenaCommunicator is an athenahealth service that allows your practice to communicate with patients using automated appointment reminders (phone calls, emails, and text messages) and directly through a "Patient Portal," which your patients can access from your medical practice's own website.
	Enterprise ID / EnterpriseID	An Enterprise ID is an identifier that links multiple Patient IDs for any patient that spans multiple tablespaces. The Enterprise ID represents the entire patient record across all provider groups, whereas the Patient ID represents the patient within a specific provider group. Enterprise IDs are for organizations that use the Common Patient Index.
	Patient Information Center	The Patient Information Center is a slimmed-down version of the athenaCommunicator Patient Portal. athenahealth provides the Patient Information Center for practices with athenaClinicals that do not have athenaCommunicator or the Patient Portal component enabled. Your patients can use the Patient Information Center to view, download, and transmit their health information. Alternate names: PIC, Electronic Patient Care Summary
	ReminderCall	An athenahealth term. The ReminderCall service generates automated phone, email, and text messages to remind patients about appointments and give pre-appointment instructions. The ReminderCall service is available to all athenaOne practices with athenaCollector or athenaCommunicator.
	GroupCall	An athenahealth term. The athenaCommunicator GroupCall service enables automated messaging campaigns targeted to specific patient populations, such as the Appointment No Shows campaign or the Weather campaign. This service is available only to practices with athenaCommunicator.
	ResultsCall	An athenahealth term. The athenaCommunicator ResultsCall service generates automated phone, email, and text messages to inform patients about their test results. This service is available only to practices with athenaCommunicator.
	athenaCollector	athenaCollector includes our highly intuitive, cloud-based practice management software that simplifies every step of the process: patient registration, scheduling, check-in, charge entry, referral management, checkout, follow-up, collections, accounting, and reporting.
	athenahealth Population Health	The service is a comprehensive population health management service that helps you achieve your quality goals for value-based reimbursement models while reducing total medical expenses.
	athenaOne for Hospitals and Health Systems	athenaOne for Hospitals and Health Systems is the athenahealth network solution for EHR, patient engagement, care coordination, and financial management services for hospitals.
	brand	A feature of athenaCommunicator. A brand is a collection of provider groups that is assigned a distinct portal URL. You can assign multiple provider groups to one Communicator brand, but each provider group can belong to only one Communicator brand. You can use Communicator brands to display the same logo and colors on the Patient Portal for a collection of provider groups.
	BYOLB	Stands for "be your own lockbox." If you do not use the athenaMailbox service to centralize the receipt and handling of remittance documents on your behalf, you can contract these services with a bank or you can act as your own lockbox. See also: athenaMailbox, lockbox
	CQM	Stands for "clinical quality measure." Clinical quality measures (CQMs) are tools that help measure and track the quality of health care services that EPs, eligible hospitals, and CAHs provide. The main difference between eCQMs and MIPS CQMs is that eCQMs require structured data to be captured electronically, often at the point of care, whereas in most cases, MIPS CQMs have some level of additional manual data collection from the medical record, often referred to as data abstraction. See also: eCQM.
	eCQM	Stands for "electronic clinical quality measure." As opposed to a CQM, an eCQM is specified in a standard electronic format and is designed to use structured, encoded data present in the electronic health record (often captured at the point of care). Health care providers are required to electronically report eCQMs to measure health care quality. These eCQMs are determined by CMS and require the use of 2015 Edition of CEHRT. To report eCQMs successfully, providers must adhere to the requirements identified by the CMS quality program in which they intend to participate.
	locum tenens	From Medieval Latin: locum tenens (one holding a place). Locum tenens physicians fill in for other physicians on a temporary basis. When a healthcare employer faces temporary staffing shortages, the employer may hire locum tenens physicians and other part-time clinicians to fill vacancies.
	CEHRT	Stands for Certified Electronic Health Record Technology. Beginning in 2019, all eligible professionals (EPs), eligible hospitals, dual-eligible hospitals, and critical access hospitals (CAHs) are required to use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Program.
	service type add-on	Service type add-ons (or STAOs) are additional claim fields available for the ANSI 837 claim format that you can use based on your practice's service specialty billing needs. Service type add-on fields are available on the Charge Entry and Claim Edit pages. Your practice selects any relevant service type add-ons during the onboarding process, but you can request other STAOs later by contacting the CSC. Service type add-ons can be configured for specific departments (the Service Department listed on claims).
	DEA number	Number assigned to a provider by the United States Drug Enforcement Administration that allows the provider to write prescriptions for controlled substances. A DEA number consists of 2 uppercase letters followed by 7 numbers, for example, AA1234567. athenahealth recommends that you capitalize the letters. If the number has more than 9 characters, the 10th character must be a dash followed by the additional numbers (for example, AA1234567-890).
	compendium	Catalog of facility-specific lab or imaging orders. These orders are called CPOTs (clinical provider order types). CPOTs are orders specific to a particular practice or organization (the clinical provider).
	nonsufficient funds (NSF)	Refers to the status of a checking account that does not have enough money to cover a transaction. NSF can refer to the fee charged when a check is presented but cannot be covered by the balance in the account.