RCM Glossary
Clear definitions.
No jargon for its own sake.
The terms that come up in every billing conversation, explained the way we'd explain them to a new hire.
- Accounts Receivable (AR)
- Money owed to the practice for services already delivered. Usually reported in aging buckets — 0–30, 31–60, 61–90 and 90+ days — because the older a balance gets, the less likely it is to be collected.
- Clean Claim
- A claim accepted and processed by the payer on first submission, with no rejection, no request for more information and no rework. Clean claim rate is the single most useful measure of whether the front of your cycle is working.
- CPT Code
- Current Procedural Terminology. The five-digit code set that describes what was done — the procedure, service or visit. Maintained by the American Medical Association.
- Credentialing
- The process of verifying a provider's qualifications and enrolling them with a payer so their services are billable. Distinct from contracting, which determines what those services are paid.
- Denial
- A claim the payer has processed and refused to pay. Different from a rejection, which never entered adjudication. Denials carry a reason code and can usually be appealed; rejections have to be corrected and resubmitted.
- EOB
- Explanation of Benefits. The paper statement showing how a claim was adjudicated — what was allowed, what was paid, what was adjusted and what the patient owes.
- ERA
- Electronic Remittance Advice. The electronic equivalent of an EOB, delivered in the 835 format so payments can be posted automatically at line level.
- ICD-10-CM
- The diagnosis code set. Where CPT says what was done, ICD-10-CM says why — and whether the two support each other decides medical necessity.
- Modifier
- A two-character suffix that changes the meaning of a CPT code without changing the code itself: that a service was distinct, bilateral, performed during a global period, or split into professional and technical parts.
- Revenue Cycle Management (RCM)
- Everything between a patient booking an appointment and the last dollar of that visit being collected — registration, eligibility, coding, claims, payment posting, AR and denials.
A term you can't find?
Ask us. We'd rather explain it than have you nod along in a vendor meeting.