Healthcare RCM
Glossary

Accounts Receivable (AR) represents the outstanding balance of money owed to a healthcare practice for services already rendered but not yet…

AR Days measures the average number of days it takes a healthcare organization to collect payment after a service is rendered. It is…

A claim denial occurs when an insurance payer refuses to honor a submitted claim for payment, either in whole or in part. Denials can be…

Claim scrubbing is the process of reviewing and validating insurance claims for errors, omissions, and payer-specific requirements before…

A clean claim is a submitted insurance claim that contains all required data elements, is free of errors, and can be processed without the…

Coordination of Benefits (COB) is the process of determining which insurance plan pays first (primary) and which pays second (secondary)…

Days Sales Outstanding (DSO) measures the average number of days it takes to collect revenue after a sale or service has been completed. In…

Eligibility verification is the process of confirming a patient's active insurance coverage, benefits, and plan details before or at the…

An Electronic Remittance Advice (ERA) is the electronic version of an Explanation of Benefits (EOB) sent from a payer to a provider…

First-pass resolution rate (also called first-pass yield or first-pass acceptance rate) measures the percentage of claims that are paid on…

Net collection rate measures the percentage of allowable charges that a healthcare organization actually collects. It is calculated by…

Payment posting is the process of recording insurance and patient payments to their corresponding accounts and claims in a practice…

Prior authorization (also called pre-authorization or pre-cert) is the process of obtaining approval from an insurance payer before…

Revenue Cycle Management (RCM) encompasses all administrative and clinical functions that contribute to the capture, management, and…

A write-off in healthcare billing is the portion of a charge that a provider removes from a patient's account balance. Write-offs can be…

CPT codes are a standardized medical code set maintained by the American Medical Association (AMA) used to describe medical, surgical, and…

Credentialing is the process of verifying a healthcare provider's qualifications, including education, training, licensure, certifications,…

An Explanation of Benefits (EOB) is a document sent by an insurance payer to both the provider and the patient that details how a medical…

ICD-10 is the international standard diagnostic classification system used to code and classify diseases, symptoms, abnormal findings, and…

Medical necessity is the standard used by insurance payers to determine whether a healthcare service, procedure, or treatment is clinically…

Remittance advice is a document accompanying a payment from an insurance payer that provides a detailed breakdown of how claims were…