Healthcare RCM Glossary

Healthcare RCM Glossary, 50 essential terms.

Definitions, key points, and operational context for the 50 most-used terms in healthcare revenue cycle management. From GCR and NCR to PPS, DRG, HCC, RAF, EPSDT, OASIS, RAP, and 40+ more. Maintained by the ASP-RCM Solutions team.

270/271 Eligibility Verification→ 277 Claim Status→ 835 Electronic Remittance Advice→ 837 Electronic Claim→ ABA CPT Codes (97151-97158)→ ABA Medical Necessity→ ABA Prior Authorization→ Accounts Receivable (A/R) Aging→ Board Certified Behavior Analyst (BCBA)→ CAQH (Council for Affordable Quality Healthcare)→ CPT and HCPCS Modifiers→ Case Mix Index (CMI)→ Claim Denial Reason Codes (CARC)→ Clearinghouse→ Diagnosis-Related Group (DRG)→ Discharged Not Final Billed (DNFB)→ EHR Integration→ EPSDT (Early and Periodic Screening, Diagnostic, and Treatment)→ FHIR (Fast Healthcare Interoperability Resources)→ Gross Collection Rate (GCR)→ HIPAA (Health Insurance Portability and Accountability Act)→ HITRUST CSF→ HL7 v2 Messaging→ Hierarchical Condition Category (HCC)→ Medicaid Fee-for-Service (FFS)→ Medicaid Managed Care (MCO)→ Medicare Administrative Contractor (MAC)→ Medicare Part A→ Medicare Part B→ Medicare Part C (Medicare Advantage)→ Medicare Part D→ National Provider Identifier (NPI)→ Net Collection Rate (NCR)→ Net Patient Service Revenue (NPSR)→ Payer Contract Management→ Payer Mix→ Prospective Payment System (PPS)→ Provider Credentialing→ Provider Enrollment→ RAC (Recovery Audit Contractor) Audit→ RADV (Risk Adjustment Data Validation) Audit→ RAP and Final Claim (Home Health)→ Recredentialing→ Registered Behavior Technician (RBT)→ Revenue Cycle→ SMRC (Supplemental Medical Review Contractor) Audit→ SOC 2 Type II→ TPE (Targeted Probe and Educate) Audit→ Taxonomy Code→ UPIC (Unified Program Integrity Contractor) Audit→