Clear definitions of billing, coding, and revenue cycle terms—from EOBs and denials to AR, patient collections, and hospital CDM—written for providers and RCM teams who need accurate, practical context fast.
The Charge Description Master (CDM) is a hospital’s comprehensive itemized master file of billable services, supplies, and charges used to generate claims and patient statements. It links clinical services to charge codes, pricing, and billing logic.
Patient collections are the processes and policies providers use to identify, communicate, and collect patient financial responsibility for healthcare services—both before and after care.
Clinical denials are payer decisions to deny payment based on clinical criteria such as medical necessity, level of care, or coverage exclusions. They require clinical documentation, coding, and utilization review to resolve.
Accounts receivable (AR) in healthcare are billed but unpaid amounts owed to providers by payers and patients. AR tracks outstanding claims, patient balances, adjustments, and collections across the revenue cycle.
A Participating Physician (PAR) is a clinician who has contracted with a payer to accept negotiated fees and follow network rules. PAR status affects reimbursement, patient liability, and administrative workflows in billing and contracting.
MS-DRG (Medicare Severity Diagnosis-Related Group) is the inpatient classification system Medicare uses to group hospital stays by clinical similarity and resource use to determine prospective payment under IPPS.
Per Member Per Month (PMPM) is the average cost or revenue allocated to each enrolled member for a single month. It standardizes financial measurement across populations for budgeting, contracting, and performance tracking.
Coordination of Benefits (COB) is the process insurers use to determine payment order when a patient has multiple health coverages. It assigns primary and secondary payers, allocates payments, and identifies member financial responsibility.
An Explanation of Benefits (EOB) is a payer-generated statement that explains how a claim was processed, including payments, adjustments, denials, and patient responsibility. Providers use EOBs to post payments, pursue appeals, and prepare accurate patient statements.
Accountable Care Organizations (ACOs) are provider-led networks that assume joint responsibility for the quality and cost of care for an attributed patient population. They align incentives across clinicians, hospitals, and payers to reward value over volume.
