Evaluation and analysis of the medical necessity, appropriateness, and efficiency of medical services given in an ambulatory facility. Utilization review is typically performed by a utilization review committee.

AVGs were replaced by ambulatory patient groups (APGs) as an outpatient classification system by Health Systems International (HSI). Then ambulatory surgery categories (ASCs) were adopted, replacing APGs for outpatient or 1-day surgery cases that were derived from the surgery section of the CPT. Later this was replaced by the ambulatory payment classification (APC) system.

Under HIPAA’s final privacy rule, an amendment to a patient’s medical record indicates that the data are in dispute while retaining the original information, while a correction to a medical record alters or replaces the original record.

National organization that was formed as a result of a merger of the Health Insurance Association of America (HIAA), Group Health Association of America (GHAA), American Managed Care and Review Association (AMCRA), and American Association of Health Plans (AAHP). Their member companies offer insurance coverage for medical expenses, long-term care, disability income, dental, supplemental, stop-loss, and reinsurance to consumers, employers, and public purchasers. Its purpose is to represent the interests of their members on legislative and regulatory issues at the federal and state levels, and with the media, consumers, and employers. They provide information and services such as newsletters, publications, a magazine, and on-line services. They also conduct education, research, and quality assurance programs and engage in a host of other activities to assist their members. AHIP participates in the maintenance of some code sets including the HCPCS Level II codes.

AAFP and its members are committed to care that is equitable for all people; centered on the whole person within the context of family and community; based on science, technology, and best available evidence; supported by lifelong professional learning; and grounded in respect and compassion for the individual. AAFP’s vision is to transform health care to achieve optimal health for everyone. The mission of the AAFP is to improve the health of patients, families, and communities by serving the needs of members with professionalism and creativity.

Nonprofit organization for orthopaedic surgeons and allied health professionals.

National organization that represents physician assistants (PAs) in all specialties and all employment settings. Its membership also includes PA students and supporters of the profession. Its mission is to promote quality, cost-effective, accessible health care and the professional and personal development of PAs.

National organization composed of medical coders and billers. It offers examinations for becoming a Certified Professional Coder (CPC), Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder-Hospital (CPC-H), and Certified Professional Coder-Payer (CPC-P).