I gathered this information from a few websites, however I did use Wikipedia more often than others. If you need more information on any of those listed below, I recommend a quick trip to Wikipedia. If it does not answer all your questions, it will be a great place to start.

-A-

ANOC – (Annual Notice of Change) – personalized letter sent to all plan members highlighting changes to their benefits and costs for the coming year. The letter format must be approved by CMS ensuring that Medicare Advantage plan members receive complete information about their coverage.

A.P. (Adjusted Payments) – are claims payments which are adjusted according to regional factors as well as income and life changing events.

-C-

CPT / CPT 4 Codes or Level 1 Codes (Current Procedural Terminology) – Uniform standard copyright protected by the American Medical Association describing medical, surgical and diagnostic services.

-D-

DRG (Diagnosis Related Group) – System which classifies hospital cases into groups. These groups may also be referred to as “product groups” which a hospital provides. These groups are used by Medicare to establish reimbursements for related services such as home healthcare providers.

DSH Payments (Medicare Disproportionate Share) – payment adjustments according to a prospective reimbursement system to hospitals, especially those supporting low income communities. This adjustment compensates hospitals for the higher operating costs incurred in treating a large share of low-income patients.

-E-

EHR (Electronic Health Records) — This is a concept causing a lot of discussion in healthcare circles. The basic concept is that a person would have a set of electronic health records which follow him from the cradle to the grave. In some discussions a genetic profile would be included. Such records would be used by doctors to more easily advise their patients in maintaining a healthy lifestyle. This data could also serve as a standard source of information between doctors, health insurance companies and the individual.

EOC (Evidence of Converge) — Each fall health plans must issue evidence of coverage.  The EOC gives details about what the health insurance plan covers, how much the member pays and much more. This document is mandated and defined by CMS.

-F-

Fee Schedules – Published schedule for payment to physicians by Medicare. Example: A CPT code is accompanied by a predefined payment. There are separate schedules for Part A, B and C.

Formulary (Part D) – Includes:

• Plan Name
• Plan ID
• Monthly Premium
• Deductible
• Plan qualifies for LIS

Drug Tear Information (Logical grouping of prescription drugs on the Part D formulary. This includes the “Tear Number”, “Drug Description”. )

• Cost Sharing from preferred network pharmacies, mail order (Up to a 90 day supply)
• Drug Utilization Management or Coverage Rules
• None
• P – Prior Authorization
• S – Step Therapy
• Q – Quantity Limits (amounts / days)

-H-

HPCPS Codes (Health Care Common Procedure Coding System) – Is a standardized coding system used by Medicare and other health insurance programs ensuring health care claims are processed in an orderly and consistent manner. HPCPS codes have two “levels”. Level 1 is comprised of CPT (Current Procedural Terminology). Level 2 is for non-physician services such as ambulance services and prosthetic devices. Level 2 codes are followed by four numeric digits.

-I-

ICD-9 Codes (Ninth revision of the International Classification for Diseases) – International classification of diseases. adopted by the U.N.

ICD-10 Codes (Tenth revision of the International Classification for Diseases) – International classification of diseases. adopted by the U.N. Improves ninth revision by allowing for more than 14,400 different codes and permits for the tracking of new diagnoses. This code set can be expand to include more than 16,000 codes using the optional sub-classifications. W.H.O provides an online browser of these codes.

ICD-10 CM – Code set used by the U.S. that contains some 68,000 codes.

ICD-10 PCS – Code set used by the U.S. that contains some 68,000 codes.

ICD-10 Adoption – The deadline for the adoption of the US CM and PCS versions of the ICD-10 codes is October 1, 2014.

-L-

LIS – Low Income Subsidy

-N-

NDC (National Drug Code) – This code is a unique product identifier used in the United States for drugs intended for human consumption.

-P-

Provider Directory – PCP’s participating in Medicare services.

-R-

RBRVS (Resource-based Relative Value Scale) – Assigns procedures performed by a physician or other medical provider an adjusted value by geographic region. This value scale determines how much a procedure is worth based on region. This scale is used by Medicare, and nearly all HOM’s.

-S-

Summary of Benefits – Lists benefits of package. Is required by CMS.

-T-

Title 21 CFR Part 1I (Code of Federal Regulations) – Part 11 as it is commonly called, defines the FDA criteria under which electronic records and electronic signatures are considered trustworthy and equivalent to paper records.

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Edit: Please excuse the interviewer’s extreme dyslexia. With “Freedom” they mean the American’s definition of it. The everyday “media term”, or “catch phrase” in relation to democracy, and government. Political / political catch phrase.
She does not mean “personal freedom”. She is a borderline anarchist.

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