Resources
Definitions and explainers, kept separate from sales claims.
Use the journal for the long explanations, the glossary for the short ones, and the assessment when you want the questions applied to a practice.
Articles
- Eligibility Mistakes That Delay Payment
- How to Read a Claim Denial
- CPT 99213 and 99214 for Established Visits
- How Technology Supports Revenue Cycle Work
- Understanding ERA, EOB, and EFT
- Medical Billing Challenges for Small Practices
- Key Medical Billing KPIs, Explained
- A Practical Guide to Provider Credentialing
- How Insurance Eligibility Verification Works
- Common Medical Billing Mistakes
- What Is a Clean Claim?
- Strategies to Reduce Days in A/R
- Understanding Medical Claim Denials
- In-House vs Outsourced Medical Billing
- A Complete Guide to Revenue Cycle Management
Glossary
- RCM
- Revenue cycle management. The administrative path from scheduling through final payment.
- CMS-1500
- The professional claim form. Electronic professional claims carry the same core data in an 837P.
- UB-04
- The institutional claim form. Facility billing on this form is not a service offered on this site.
- ICD-10-CM
- The diagnosis code set used to report why a service was performed.
- CPT
- The procedure and visit code set most professional claims use.
- HCPCS
- Codes for many supplies, drugs, and services that CPT does not cover. Level II is the set billers mean most often.
- NPI
- National Provider Identifier. Billing and rendering providers are identified with it on claims.
- 837
- The electronic claim transaction. 837P is professional. 837I is institutional.
- 835
- The electronic remittance advice. It explains payment and adjustment. It is not the deposit.
- ERA
- Electronic remittance advice, the 835 as a file the billing system can post.
- EOB
- Explanation of benefits. The readable version of a payment decision, for the practice or the patient.
- EFT
- Electronic funds transfer. The deposit. It should be reconciled to the remit.
- 270/271
- The eligibility inquiry and the payer's response.
- 276/277
- The claim-status inquiry and response. A 277 can also acknowledge whether a claim was accepted.
- Clearinghouse
- An intermediary that edits and routes claims and can return acknowledgements and remits.
- CARC
- Claim adjustment reason code. It says why a line was adjusted or denied.
- Clean claim
- A claim complete enough to be accepted for adjudication. Acceptance is not payment.
- Days in A/R
- Outstanding receivables divided by average daily charges. The exclusions have to be written down.