
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.
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.
Browse the Billing Glossary
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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Complete Billing Glossary Index
Browse all entries with definitions and billing guidance.
Accounts Receivable in Medical Billing: Definition and Management
Accounts receivable in medical billing is the total unpaid claims owed by payers and patie…
View Details CLEAN.CLAIMClean Claim in Medical Billing: Definition and Requirements
A clean claim passes all edits and processes without additional information. Learn what ma…
View Details REMITTANCE.ADVICERemittance 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…
View Details EXPLANATION.OF.BENEFITSExplanation of Benefits (EOB): Definition and How to Read It
An Explanation of Benefits shows how an insurance claim was processed. Learn what each sec…
View Details DENIAL.RATEDenial Rate in Medical Billing: Definition and Benchmarks
Denial rate measures the percentage of claims denied by payers. Learn how to calculate it,…
View Details DAYS.IN.ARDays 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…
View Details NET.COLLECTION.RATENet Collection Rate: Definition and Benchmarks for Medical Billing
Net collection rate measures what percentage of collectible revenue is actually collected.…
View Details FIRST.PASS.RESOLUTION.RATEFirst Pass Resolution Rate: Definition and How to Improve It
First pass resolution rate is the percentage of claims paid on first submission. Learn how…
View Details CLEARINGHOUSEMedical Billing Clearinghouse: What It Is and How It Works
A medical billing clearinghouse validates and routes claims from providers to payers. Lear…
View Details NPI.NUMBERNPI Number in Medical Billing: Definition and Enrollment
The NPI is a 10-digit unique identifier required on all medical claims. Learn about Type 1…
View Details COORDINATION.OF.BENEFITSCoordination of Benefits (COB): Definition and Billing Rules
Coordination of benefits determines which payer pays first when a patient has multiple ins…
View Details FEE.SCHEDULEFee 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…
View Details WRITE.OFFWrite-Off in Medical Billing: Definition and Types
A write-off is an amount removed from a balance that cannot be collected. Learn the types …
View Details SUPERBILLSuperbill in Medical Billing: Definition and What to Include
A superbill is an itemized receipt listing all services, diagnosis codes, and charges for …
View Details ELECTRONIC.REMITTANCE.ADVICEElectronic Remittance Advice (ERA): Definition and How It Works
ERA is the electronic version of the payment explanation sent by payers. Learn how ERA 835…
View Details CHARGE.ENTRYCharge Entry in Medical Billing: Definition and Process
Charge entry is the process of entering billed services and codes into the practice manage…
View Details MEDICAL.NECESSITYMedical Necessity in Medical Billing: Definition and Documentation
Medical necessity is the payer standard for covered services. Learn how to document it, ap…
View Details PRIOR.AUTHORIZATIONPrior Authorization in Medical Billing: Definition and Process
Prior authorization is a payer requirement to approve services before they are provided. L…
View Details UPCODINGUpcoding in Medical Billing: Definition and Legal Risk
Upcoding means billing for a higher-level service than was provided. Learn what constitute…
View Details DOWNCODINGDowncoding in Medical Billing: Definition and Revenue Impact
Downcoding means billing a lower-level service than what was documented. Learn how it caus…
View Details HCPCS.CODESHCPCS Codes in Medical Billing: Level II Code Reference
HCPCS Level II codes cover services not in CPT including drugs, DME, and non-physician ser…
View Details DRG.CODESDRG Codes in Medical Billing: Hospital Inpatient Payment Reference
DRG codes are used for hospital inpatient billing under Medicare's prospective payment sys…
View Details ALLOWED.AMOUNTAllowed 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…
View Details TIMELY.FILINGTimely Filing in Medical Billing: Deadlines and How to Appeal
Timely filing is the deadline for submitting claims after the date of service. Learn deadl…
View Details CLAIM.SCRUBBINGClaim Scrubbing in Medical Billing: Definition and How It Works
Claim scrubbing is the pre-submission review of claims for errors before sending to payers…
View DetailsBilling 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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