Understanding the data standards and audit programs under Medicare and Medicaid is made more challenging by the alphabet soup of acronyms that government officials love. This guide should help.

• CA - (also see CMS) - Each CMS consortium is led by a Consortium Administrator (CA) who serves as the Agency's national focal point in the Field for their business line(s) and as such is responsible for consistent implementation of CMS programs, policy and guidance across all ten regions for matters pertaining to their business line.  In addition to responsibility for a business line, each CA also serves as the Agency's senior management official for two or three ROs, representing the CMS Administrator in external affairs matters and overseeing administrative operations.
• CDC - Centers for Disease Control
• CMS - Centers for Medicare & Medicaid Services (CMS) has ten Regional Offices (ROs) reorganized in a Consortia structure based on the Agency's key lines of business: Medicare health plans, Medicare financial management, Medicare fee for service operations, Medicaid and children's health, survey & certification and quality improvement. Also see this page.
• DRA - The 2005 Deficit Reduction Act (DRA) requires CMS to contract with Medicaid Integrity Contractors (MICs) to audit claims, ensuring that paid Medicaid claims were:
  • For services provided and properly documented
  • For services billed properly using appropriate procedure codes
  • For covered services
  • Reimbursed appropriately according to state policies rules and regulations
• DRG - Diagnosis Related Groups or payment groups.  Patients who have similar clinical characteristics and similar costs are assigned to a DRG.  The DRG will be linked to a fixed payment amount based on the average cost of patients in the group.  Patients are assigned to a DRG based on diagnosis, surgical procedures, age and other information. Hospitals provide this information on their bills and Medicare uses this information to decide how much the hospitals should be paid.
• HIPAA - The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II)  (also known as the Kassebaum-Kennedy legislation) required the Department of Health and Human Services (HHS) to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addressed the security and privacy of health data. As the industry adopts these standards for the efficiency and effectiveness of the nation's health care system will improve the use of electronic data interchange. 
• MIC - Medicaid Integrity Contractor - for Medicaid
• MIP - Medicare Integrity Program -HIPAA includes a provision establishing the "Medicare Integrity Program." That provision gives the Centers for Medicare and Medicaid Services (CMS) specific contracting authority, consistent with Federal Acquisition Regulations, to enter into contracts with entities to promote the integrity of the Medicare program. Pursuant to that MIP authority, CMS awarded twelve Indefinite Delivery-Indefinite Quantity (IDIQ) contracts for the Program Safeguard contractor (PSC) effort in May 1999. Information on the PSC awardees and the IDIQ task orders is available. In addition, CMS awarded the Coordination of Benefits (COB) contract to GHI Medicare in November 1999. CMS also made multiple awards of an IDIQ contractor to Medicare Managed Care (MMC) Program Integrity Contractors
• RAC - Recovery Audit Contractor  - See this page for more information. for Medicare