Revenue Cycle Management

Revenue

The total amount of money that a business receives from its normal operations over a period of time (such as a year).

Accounts receivable

The amounts owed to a medical practice for services rendered.

Cash flow

The cash a business has generated and has available for use. Reimbursement from insurance companies and patient payments provides the cash flow for a medical office.

Primary insurance

The insurance responsible for paying claims first.

Secondary insurance

The insurance responsible for paying claims second.

Tertiary insurance

The insurance responsible for paying claims third.

Claims submission

The transmission of claims data to payers for processing.

Electronic data interchange

Computer-to-computer transfer of data between providers and third-party payers.

Clearinghouse

The middleman in the claims submission process, making it easier for providers to submit claims to many different insurance carriers

Clean claim

A claim with no obvious errors that can move on to be reviewed by the insurance company.

Guarantor

The individual who takes responsibility to pay the medical costs.

Allowable charges

This is the maximum amount that an insurer will reimburse for a covered service or procedure. Allowable charges are never more than the provider's fee.

Coordination of benefits

When the patient is covered by more than one insurance policy, the primary insurance is billed for the full amount, and the secondary insurance is billed only for any balance remaining.

Birthday rule

Determines the primary payer for a child when each parent subscribes to a different health insurance plan.

Price transparency

The practice of disclosing healthcare costs prior to receiving services so patients may better assess treatment options.