CCMA Revenue and Billing

Revenue Cycle

Complete financial process — from verifying eligibility to collecting final payment

Charge Reconciliation

Verifying all services are accurately billed and payments correctly posted

Accounts Receivable (A/R)

Total money owed for services rendered but not yet paid

A/R Aging Report

Groups outstanding balances by time unpaid to prioritize collection

Contractual Adjustment

Difference between billed charge and insurance-agreed amount. Written off.

Write-Off

An amount removed from a balance deemed uncollectable

Clearinghouse

A third party that checks claims for errors, reformats, and forwards to insurers

Clean Claim

A claim with all required info and no errors

Timely Filing

Claims must be submitted within a specified number of days or they are denied

Explanation of Benefits (EOB)

Insurance document showing what was covered, paid, adjusted, and patient owes

Adjudication

Insurance review of a claim to determine payment or denial

Fee-for-Service

Payment model where providers are reimbursed for each individual service

Value-Based Care

Reimbursement rewarding quality outcomes rather than volume of services

Cycle Billing

Billing accounts in segments throughout the month to distribute workload

Advance Beneficiary Notice

Medicare form notifying a patient a service may not be covered. Must be signed before service