Accounts receivable (A/R)
Amounts recorded as outstanding for services. An aging report groups those balances by elapsed time using the report’s defined starting date.
Understand the contextThe working vocabulary
The terms. In human terms.
A practical glossary for medical billing learners and working teams. Each definition leads to the workflow that gives it context.
Adjudication
A payer’s processing of a claim to determine its disposition, payment and adjustments under the applicable rules.
Understand the contextAdjusted collection rate
Payments net of credits divided by charges after approved contractual adjustments, expressed as a percentage.
Understand the contextAging
A view of outstanding balances organized by elapsed time. Always check whether the report ages from service, billing or another date.
Understand the contextAppeal
A request to review an adverse determination through the applicable payer or program process. The required route, evidence and deadline depend on the context.
Understand the contextAuthorization
A payer or program approval required for some services. Track what was approved and its scope; approval alone does not resolve every payment condition.
Understand the contextCharge capture
The workflow that records billable services and supplies from the documented encounter for further coding and billing review.
Understand the contextClaim adjustment reason code (CARC)
A standardized code explaining why a payment or adjustment differs from the amount billed. Read it with the remittance’s group and remark information.
Understand the contextClaim rejection
A claim or transaction that fails an acceptance or processing requirement. Investigate the response before choosing a correction or resubmission.
Understand the contextClean claim
A claim meeting the applicable completeness and processing requirements. Operational clean-claim metrics differ, so state the definition used.
Understand the contextClearinghouse
An intermediary in electronic healthcare transactions that can translate, check and route claims or other exchanges.
Understand the contextContractual adjustment
An adjustment arising from the payment terms of an applicable payer agreement. Keep it separate from other write-offs when measuring collections.
Understand the contextCPT
Current Procedural Terminology, the AMA’s code set for reporting medical services and procedures. Consult the current authorized reference for code-specific decisions.
Understand the contextCredentialing
Review and verification of a healthcare professional’s qualifications. Track payer enrollment and contracting as related but distinct processes.
Understand the contextDenial
An adverse adjudication decision concerning a claim or service. Use the complete payer response to establish the cause and available next steps.
Understand the contextElectronic data interchange (EDI)
Structured electronic exchange of business information, including healthcare eligibility, claim and payment transactions.
Understand the contextElectronic funds transfer (EFT)
The electronic movement of funds. The payment needs to be associated with the relevant remittance for reconciliation.
Understand the contextElectronic remittance advice (ERA)
Electronic information explaining a payer’s claim payments and adjustments. It supports posting and investigation but is separate from the funds transfer.
Understand the contextEligibility verification
Checking coverage and benefit information for the relevant patient, plan and date. Use the response within the context of the planned service.
Understand the contextFirst-pass acceptance
The share of initial submissions accepted without a correction at a specified processing stage. State the stage and denominator when reporting it.
Understand the contextGross vs. net
Gross values precede defined reductions; net values reflect those reductions. Specify the adjustments included before combining financial inputs.
Understand the contextHandoff
Transfer of work between people or teams. A useful handoff preserves the context, the next action, the owner and the due date.
Understand the contextKey performance indicator (KPI)
A defined measure used to monitor a process or result. Its source, population, timing and intended management decision should be explicit.
Understand the contextMedicare Administrative Contractor (MAC)
A contractor administering specified Original Medicare functions in a jurisdiction. Identify the relevant contractor for the provider and question.
Understand the contextNet days in A/R
Net patient receivables divided by average daily net patient service revenue. Keep the numerator and denominator on the same net basis.
Understand the contextPayer enrollment
The process of establishing a provider’s billing participation or record with a payer or program, subject to its requirements and effective approval.
Understand the contextPayment posting
Recording payments and adjustments against the appropriate accounts, with reconciliation to the remittance and related funds.
Understand the contextRemittance advice remark code (RARC)
A standardized remark adding explanation about a claim adjustment or remittance processing. Read it alongside the other response information.
Understand the contextRevenue cycle management (RCM)
The connected work that carries a healthcare encounter from patient access and documentation through billing, payment and account resolution.
Understand the contextRoot-cause review
Investigation of the conditions producing a recurring problem, with a practical corrective action and a later check for recurrence.
Understand the contextTimely filing
The applicable deadline for submitting a claim or related action. Verify the current payer or program requirements and retain the required evidence.
Understand the contextWork queue
A group of accounts organized around an actionable responsibility or status, with a clear entry condition, owner and completion condition.
Understand the contextDefinitions in context
These introductory explanations accompany the linked topic guides. For transaction and code-specific details, consult the primary references.