The following seven definitions are need to know for AccuReports® Users.  The Alphabetized Healthcare Acronyms Defined section that follows provides more general information for healthcare business professionals.

FRG and AccuReports® Basics

FRG       Financial Recovery Group

Financial Recovery Group is a healthcare information technology company established in 1999 first to perform overpayment and recovery audits for health plans and later adding the two service lines of online analytical reporting software and medical economics advisory services for substantial financial risk and value-based contracts.

AR6       AccuReports® Version Six

AccuReports® Version Six is application software produced by FRG in 2019 to make it easy to identify opportunities to improve the financial performance of risk, shared savings and incentive contracts. Drill-through group, center and PCP summaries to member-level revenue, claims and pharmacy detail.  AccuReports® was originally released in 2001 to help health plans distribute data and provider organizations aggregate data from multiple health plans.  It has been re-released with enhancements in 2005, 2011, 2014 and 2019.

EFR        Expense to Funding Ratio

The Expense to Funding Ratio is the fraction created by dividing the total medical expenses for a panel of members for a chosen time period by the corresponding medical cost budget.  The medical cost budget is computed by multiplying the premium available to the risk pool by the target medical loss ratio for the panel manager (e.g. the group, center or PCP).  EFRs below 100% mean the panel is consuming fewer resources than are allocated and thus creating a surplus or savings.  EFRs over 100% indicate the presence of a deficit from either a revenue shortfall or an excess expense trend.

IBNR     Incurred But Not Reported

IBNR is an estimate of medical claims that are expected to be presented for payment for a historical period but for a variety of reasons have not actually yet been paid.  These estimates are made by the actuarial staff of a site sponsor or by the health plan that is the source of the IBNR data.  IBNR is most volatile in the three most recent past months because that period is the least complete.

LMS       Learning Management System

A Learning Management System is a software application for the administration, documentation, tracking, reporting and delivery of educational courses or training programs.  FRG’s LMS helps new AccuReports® users learn the basics of the system and become certified through instructional videos and knowledge checks.

MLR      Medical Loss Ratio

A Medical Loss Ratio is the fraction created by dividing the total medical expenses for a panel of members for a chosen time period by the total premium collected.  Plan sponsors like CMS and state-specific Medicaid programs can mandate that HMOs spend a specific percentage (e.g. 85%) of premium collected on medical costs in aggregate.  In many cases, any underspend is returned to the sponsor.  Mathematically, MLR is computed as follows: if an insurer spends 80 cents out of every premium dollar to pay medical claims and fund activities that improve the quality of care, the insurer has a medical loss ratio of 80%.  The MLR is equivalent to the EFR multiplied by the Target Loss Ratio for the panel.

PMPM  Per Member Per Month

Per Member Per Month is a common insurance mechanism to express and compare medical economics statistics.  Since the size of a population has a direct impact on the revenue provided to support its needs and the expenses paid for its medical services, converting revenue and expense items for a population into PMPMs allows an analyst to understand the average trends and compare them to others.  Appropriate use PMPM statistics to develop comparisons requires understanding the underlying population and knowing the number of months in the computation.

Alphabetized Healthcare Acronyms Defined

A  B  C  D  F  G  H  I  J  K  L  M  N  O  Q R   U  V  W  X  Y  Z

ACO      Accountable Care Organizations

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers who voluntarily affiliate to provide coordinated high-quality care to their Medicare patients.  For more information visit: https://innovation.cms.gov/initiatives/ACO/

AMA     American Medical Association

The American Medical Association (AMA) was founded in 1847 and incorporated in 1897.  It is the largest association of physicians, both allopathic (MD) and osteopathic (DO), and medical students in the United States.

CCLF      Claim and Claim Line Feed

Claim and Claim Line Feed (CCLF) files are provided by CMS to ACO’s on a regular basis during the contract period so that they may understand the resource use patterns of their assigned population.  CCLF files do not contain data on Medicare beneficiaries who have elected not to share their medical claims data.  When an ACO has a defined service network provider roster, these files can be organized to understand whether assigned beneficiaries are receiving services within the ACO’s clinically integrated network or outside thereof.  Interestingly, CCLF files can also include claims history for individuals who are not listed on the attribution table.  FRG believes this data can be used to identify the members who may become attributed in the future due to having a history of service with an ACO provider.

CDHP    Consumer-Directed Health Plan

Consumer-Directed Health Plans (CDHPs) come in various forms, but most commonly a CDHP offers a high-deductible health plan paired with a spending account for out-of-pocket costs such as a Health Savings Account (HSA) or integrated Health Reimbursement Arrangement (HRA).

CHIP      Children’s Health Insurance Program

The Children’s Health Insurance Program (CHIP) is administered by the United States Department of Health and Human Services and provides matching funds to states providing health insurance for families with children.

CMPL    Civil Monetary Penalties Law

The Civil Monetary Penalties provisions of 42 U.S. Code § 1320a–7a. authorize the Secretary of Health and Human Services to assess fines and exclude individuals and organizations from federal programs if they are found to have defrauded or abused the resources of Medicare and Medicaid programs.  Follow these links for additional information: https://oig.hhs.gov/fraud/enforcement/cmp/cmpa.asp or