Medical billing comes with its own language, and that language can make an already stressful process feel even more confusing. Maryland Medical Billers built this glossary so practice owners, office managers, and providers can understand exactly what is happening with their claims without needing a billing background. Below are the terms our clients ask about most often, explained the way we would explain them on a phone call, not the way a textbook would.
Medical Billing
Medical billing is the process of submitting claims to insurance companies, including Medicaid and Medicare, to get paid for healthcare services. It covers everything from entering the correct codes to tracking the claim until payment is received.
Medical Billing Company
A medical billing company is an outside business that handles all or part of a healthcare practice’s billing process. This can include claims submission, claims follow-up, denial management, and revenue cycle reporting, allowing the practice to avoid hiring and managing an internal billing team.
Medical Claims Billing
Medical claims billing refers specifically to the process of preparing and submitting a claim form to an insurance payer for reimbursement of services rendered to a patient.
Outsourced Medical Billing
Outsourced medical billing means a practice has hired an external company, rather than internal staff, to manage its billing functions. This often reduces overhead while improving consistency, since an outsourced team is focused entirely on billing rather than juggling it alongside other front desk duties.
Healthcare Billing
Healthcare billing is a broad term covering all financial transactions between a healthcare provider, the patient, and insurance payers, including claims submission, payment posting, and patient billing for any remaining balance.
Revenue Cycle Management
Revenue cycle management, often shortened to RCM, refers to the entire financial process of a patient encounter, starting with insurance verification before the visit and ending with the claim being fully paid or resolved. It includes claims submission, follow-up, denial management, payment posting, and reporting.
RCM Billing
RCM billing is another way of referring to the billing functions performed as part of revenue cycle management, including claims submission, payment posting, and accounts receivable follow-up.
Claims Submission
Claims submission is the act of sending a completed claim form to an insurance payer for processing and reimbursement. A clean claim, meaning one without errors, is more likely to be paid on the first submission.
Claims Follow Up
Claims follow-up is the process of checking on a claim after it has been submitted to confirm it is processing correctly, and contacting the payer if it has not been resolved within a normal turnaround window.
Denial Management
Denial management is the process of reviewing claims that an insurance payer has refused to pay, identifying the reason, correcting the issue, and resubmitting the claim when appropriate.
Claim Denial Management
Claim denial management refers to the same process as denial management, with a specific focus on tracking denial patterns across an entire practice to reduce repeat errors over time.
Rejected Claims Correction
Rejected claims correction involves fixing claims that were rejected before processing, often due to formatting errors or missing information, and resubmitting them correctly.
Provider Credentialing
Provider credentialing is the process of verifying a healthcare provider’s qualifications and getting them approved to bill specific insurance payers. Without proper credentialing, a provider cannot be reimbursed by that payer.
Insurance Credentialing
Insurance credentialing is another term for provider credentialing, specifically referring to the approval process required by each insurance company before a provider can submit claims to that payer.
CAQH Setup
CAQH stands for the Council for Affordable Quality Healthcare. The setup refers to creating and maintaining a provider’s profile in this credentialing database, which many insurance companies use to verify provider information before approving them on a payer panel.
Payer Enrollment
Payer enrollment is the process of formally applying to and being approved by an insurance company so a provider can submit claims and receive reimbursement from that specific payer.
Medicaid Enrollment Support
Medicaid enrollment support refers to assistance with the process of enrolling a provider to bill Maryland Medicaid, which is generally done through the state’s ePREP online portal.
Medicare Enrollment Support
Medicare enrollment support refers to assistance with the process of enrolling a provider to bill Medicare, which involves federal applications and ongoing revalidation requirements.
Behavioral Health Billing
Behavioral health billing refers to claims submission and management for services related to mental health and substance use treatment, which often involve different coding and authorization rules than general medical claims.
Mental Health Billing
Mental health billing is closely related to behavioral health billing and typically refers specifically to claims for therapy, counseling, and psychiatric services.
Therapy Practice Billing
Therapy practice billing refers to the billing process specifically for individual, family, or group therapy sessions, which often have session-based codes and authorization limits set by insurance payers.
Psychiatry Billing
Psychiatry billing refers to claims for psychiatric services, including medication management visits, which may combine evaluation and management codes with therapy components.
Payment Posting
Payment posting is the process of recording payments received from insurance payers or patients against the correct claims in a practice’s billing system.
Accounts Receivable Management
Accounts receivable management refers to tracking and working unpaid claims and balances owed to a practice, prioritizing them by age and dollar value to recover revenue efficiently.
AR Follow Up
AR follow-up is the active process of contacting payers or patients about unpaid balances that have aged past a certain point, with the goal of resolving them before they become uncollectible.
Insurance Verification
Insurance verification is the process of confirming a patient’s insurance coverage is active and valid before they are seen for an appointment.
Benefits Verification
Benefits verification goes a step further than basic insurance verification by confirming exactly what services are covered under a patient’s plan, including copays, deductibles, and any prior authorization requirements.
Patient Eligibility Checks
Patient eligibility checks confirm that a patient’s insurance plan is active and that the specific services being provided are covered before the appointment takes place.
EHR Billing Setup
EHR billing setup refers to configuring an electronic health record system’s billing functions correctly, including fee schedules, payer information, and claim formatting, so claims submit cleanly from the start.
Billing Audit
A billing audit is a structured review of a practice’s billing process, claims, and accounts receivable, used to identify errors, missed revenue, and process improvements.
Who This Service Is For
- Small medical practices
- Mental health practices
- Behavioral health providers
- Therapists and counselors
- Psychiatrists and psychiatric nurse practitioners
- Group practices and expanding private practices
What We Provide
- Medical billing and claims submission
- Claims follow-up and denial management
- Payment posting and AR follow-up
- Insurance verification and eligibility checks
- Provider credentialing and payer enrollment
- Revenue cycle reporting and billing cleanup
Frequently Asked Questions
Why does medical billing use so much specialized terminology? Insurance payers each have their own rules and systems, and the terminology reflects the different stages of getting a claim from submission to payment. Understanding the terms helps practice owners ask better questions about their own billing.
Do I need to understand all of these terms to work with a billing company? No. Maryland Medical Billers explains anything relevant to your account in plain language during regular reporting and conversations. This glossary is simply a reference if you want to understand the terms on your own.
What is the difference between a denial and a rejection? A rejection happens before a claim is fully processed, usually due to a formatting or data error. A denial happens after the claim is processed, with the payer determining it will not pay for a specific reason.
Related Resources
- Maryland Medical Billers Home
- About Us | Maryland Medical Billers
- Services | Maryland Medical Billers
- Blog | Maryland Medical Billers
- FAQs | Maryland Medical Billers
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Call (410) 874-0176 today to schedule a billing review for your practice and put these terms to work for your revenue, not against it.
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