The world of Revenue Cycle Management (RCM) involves many key terms that are critical for understanding the billing and reimbursement process. Below is a glossary of essential terms to help you navigate the RCM landscape.
The amount of money owed to a healthcare provider for services rendered. AR includes outstanding insurance claims and patient balances.
The process of documenting and recording medical services and procedures provided to patients, ensuring accurate billing and coding.
The process of translating medical diagnoses, procedures, and services into standardized codes (ICD-10, CPT) for billing and insurance purposes.
The process of submitting claims to insurance companies or government payers for reimbursement of services provided.
The process of managing and addressing denied insurance claims, identifying reasons for denial, and resubmitting claims or appealing denials.
The portion of a patient’s medical bill that is not covered by insurance, including deductibles, co-pays, and coinsurance amounts.
A document sent by an insurer to a healthcare provider detailing the payment or denial of a claim, including explanations for any adjustments made.
The payment made by insurance companies or government payers to healthcare providers for services rendered to patients.
Refers to patients who pay for their medical expenses directly, without insurance coverage or as part of their insurance's patient responsibility.
The practice of assigning a higher-level code than what is warranted for the services rendered, often in an attempt to receive higher reimbursement.
Our team of experts is here to assist you with every aspect of the Revenue Cycle Management process. Whether you need help with coding, claims, or denials, we have the solutions for you.
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