Billing Glossary

Medical Billing Glossary: Complete A-Z Terms and Definitions

Complete A-Z glossary of medical billing terms. Clear definitions for AR, clean claim, denial rate, fee schedule, remittance advice.

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Medical Billing Glossary at a Glance

Medical billing terminology spans coding, claims adjudication, payer rules, and revenue cycle operations. Whether you are managing medical billing in-house or evaluating an outside billing partner, understanding these terms is essential for interpreting remittance advice, benchmarking performance, and identifying where revenue is being lost.

  • This glossary provides plain-language definitions for every major term used in medical billing and revenue cycle management.

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Medical billing terminology spans coding, claims adjudication, payer rules, and revenue cycle operations. Whether you are managing medical billing in-house or evaluating an outside billing partner, understanding these terms is essential for interpreting remittance advice, benchmarking performance, and identifying where revenue is being lost. For a full overview of how these terms connect in practice, see our guide on what is medical billing.

This glossary provides plain-language definitions for every major term used in medical billing and revenue cycle management. Each entry includes the definition, how the term applies to real billing scenarios, and related terms that affect claim adjudication, collections, and compliance.

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Medical Billing Glossary: Complete A-Z Terms and Definitions

Complete Billing Glossary Index

Browse all entries with definitions and billing guidance.

ACCOUNTS.RECEIVABLE

Accounts Receivable in Medical Billing: Definition and Management

Accounts receivable in medical billing is the total unpaid claims owed by payers and patie…

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CLEAN.CLAIM

Clean Claim in Medical Billing: Definition and Requirements

A clean claim passes all edits and processes without additional information. Learn what ma…

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REMITTANCE.ADVICE

Remittance Advice in Medical Billing: Definition and How to Read It

Remittance advice is the payer's explanation of claim payment or denial decisions. Learn h…

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EXPLANATION.OF.BENEFITS

Explanation of Benefits (EOB): Definition and How to Read It

An Explanation of Benefits shows how an insurance claim was processed. Learn what each sec…

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DENIAL.RATE

Denial Rate in Medical Billing: Definition and Benchmarks

Denial rate measures the percentage of claims denied by payers. Learn how to calculate it,…

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DAYS.IN.AR

Days in AR: Medical Billing KPI Definition and Benchmarks

Days in AR measures how long it takes to collect payment after service. Learn how to calcu…

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NET.COLLECTION.RATE

Net Collection Rate: Definition and Benchmarks for Medical Billing

Net collection rate measures what percentage of collectible revenue is actually collected.…

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FIRST.PASS.RESOLUTION.RATE

First Pass Resolution Rate: Definition and How to Improve It

First pass resolution rate is the percentage of claims paid on first submission. Learn how…

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CLEARINGHOUSE

Medical Billing Clearinghouse: What It Is and How It Works

A medical billing clearinghouse validates and routes claims from providers to payers. Lear…

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NPI.NUMBER

NPI Number in Medical Billing: Definition and Enrollment

The NPI is a 10-digit unique identifier required on all medical claims. Learn about Type 1…

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COORDINATION.OF.BENEFITS

Coordination of Benefits (COB): Definition and Billing Rules

Coordination of benefits determines which payer pays first when a patient has multiple ins…

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FEE.SCHEDULE

Fee Schedule in Medical Billing: Definition and How It Works

A fee schedule is the predetermined rate a payer will reimburse for each service. Learn ho…

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WRITE.OFF

Write-Off in Medical Billing: Definition and Types

A write-off is an amount removed from a balance that cannot be collected. Learn the types …

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SUPERBILL

Superbill in Medical Billing: Definition and What to Include

A superbill is an itemized receipt listing all services, diagnosis codes, and charges for …

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ELECTRONIC.REMITTANCE.ADVICE

Electronic Remittance Advice (ERA): Definition and How It Works

ERA is the electronic version of the payment explanation sent by payers. Learn how ERA 835…

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CHARGE.ENTRY

Charge Entry in Medical Billing: Definition and Process

Charge entry is the process of entering billed services and codes into the practice manage…

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MEDICAL.NECESSITY

Medical Necessity in Medical Billing: Definition and Documentation

Medical necessity is the payer standard for covered services. Learn how to document it, ap…

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PRIOR.AUTHORIZATION

Prior Authorization in Medical Billing: Definition and Process

Prior authorization is a payer requirement to approve services before they are provided. L…

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UPCODING

Upcoding in Medical Billing: Definition and Legal Risk

Upcoding means billing for a higher-level service than was provided. Learn what constitute…

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DOWNCODING

Downcoding in Medical Billing: Definition and Revenue Impact

Downcoding means billing a lower-level service than what was documented. Learn how it caus…

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HCPCS.CODES

HCPCS Codes in Medical Billing: Level II Code Reference

HCPCS Level II codes cover services not in CPT including drugs, DME, and non-physician ser…

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DRG.CODES

DRG Codes in Medical Billing: Hospital Inpatient Payment Reference

DRG codes are used for hospital inpatient billing under Medicare's prospective payment sys…

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ALLOWED.AMOUNT

Allowed Amount in Medical Billing: Definition and How It Works

The allowed amount is the maximum a payer will pay for a specific service. Learn how allow…

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TIMELY.FILING

Timely Filing in Medical Billing: Deadlines and How to Appeal

Timely filing is the deadline for submitting claims after the date of service. Learn deadl…

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CLAIM.SCRUBBING

Claim Scrubbing in Medical Billing: Definition and How It Works

Claim scrubbing is the pre-submission review of claims for errors before sending to payers…

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Billing Glossary, Frequently Asked Questions

Medical billing terminology spans coding, claims adjudication, payer rules, and revenue cycle operations. Whether you are managing medical billing in-house or evaluating an outside billing partner, understanding these terms is essential for interpreting remittance advice, benchmarking performance, and identifying where revenue is being lost. For a full overview of how these terms connect in practice, see our guide on what is medical billing.

This glossary provides plain-language definitions for every major term used in medical billing and revenue cycle management. Each entry includes the definition, how the term applies to real billing scenarios, and related terms that affect claim adjudication, collections, and compliance.

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