Revenue Cycle Management (RCM)

The administrative and financial process used by healthcare providers to track patient care episodes from registration and appointment scheduling through final payment.

Healthcare Provider

An individual or organization that delivers medical services, such as hospitals, physician groups, surgery centers, and clinics.

Patient Financial Responsibility

The portion of healthcare costs that the patient must pay, including deductibles, copayments, and coinsurance.

Patient Responsibility Balance

The amount owed by a patient after insurance payments and contractual adjustments have been applied.

Explanation of Benefits (EOB)

A statement from an insurance company that outlines what medical services were billed, what the insurer paid, and what the patient must pay.

Electronic Health Record (EHR)

A digital system used by healthcare providers to manage patient medical information and documentation.

Practice Management System (P.M.S.)

Software used by medical practices to manage scheduling, billing, claims, and administrative workflows.

Medical Claim

A request submitted to an insurance company for payment for medical services.

Claim Adjudication

The process by which an insurance company reviews and determines payment for a medical claim.

Patient Statement

A bill sent to a patient detailing outstanding medical balances.

Account Balance

The remaining amount owed by a patient or insurance payer after previous payments.

Write-Off

A reduction in the amount owed due to contractual agreements with insurance companies.

Patient Billing

The process of generating and sending statements to patients for outstanding healthcare balances.

Patient Statement Cycle

The schedule used to send billing statements to patients until a balance is resolved.

Self-Pay Patient

A patient responsible for paying medical costs without insurance coverage.

Point-of-Service Payment

Payment collected from a patient at the time of service.

Patient Payment Plan

An arrangement allowing patients to pay healthcare bills in installments.

Patient Balance Resolution

The process of collecting outstanding patient balances or resolving accounts through payment or adjustment.

Payment Posting

The process of applying payments received to a patient account.

Patient Payment Portal

An online platform where patients can review bills and submit payments.

Billing Transparency

Providing clear information to patients about expected healthcare costs.

Preoperative Financial Engagement

The process of communicating expected medical costs and payment options to patients before a scheduled procedure.

Preoperative Cost Estimate

An estimate of the patient’s expected out-of-pocket expenses for a planned procedure.

Insurance Eligibility Verification

Confirming that a patient’s insurance coverage is active before medical services are performed.

Benefits Verification

Reviewing a patient’s insurance plan to determine covered services, deductibles, and copayment requirements.

Deductible

The amount a patient must pay for healthcare services before insurance begins covering costs.

Copayment

A fixed amount a patient pays for a medical service under their insurance plan.

Coinsurance

A percentage of medical costs that the patient must pay after meeting their deductible.

Financial Counselling

Guidance provided to patients regarding their financial obligations and payment options.

Price Transparency

Providing clear information about healthcare pricing prior to treatment.

Early-Out Patient Billing

The process of contacting patients to collect outstanding balances shortly after insurance adjudication.

First Party Billing

Billing and collection activities that are conducted under the name of the healthcare provider rather than a third party.

Account Resolution Outreach

Communication with patients to resolve outstanding balances through payment or payment plans.

Patient Engagement Outreach

Proactive communication to help patients understand their financial obligations.

Balance Reminder Communication

Notices sent to remind patients about unpaid balances.

Digital Payment Communication

Messages that include links to payment portals or payment options.

Billing Cycle Communication

Scheduled reminders sent to patients during the billing cycle.

Bad Debt

Outstanding patient balances that remain unpaid after the provider’s internal billing efforts.

Third Party Collections

Debt collection services provided by an external company acting on behalf of the healthcare provider.

Collection Agency

A company responsible for recovering unpaid debts.

Debt Placement

The transfer of an unpaid patient account to a collections agency.

Recovery Rate

The percentage of outstanding debt successfully collected.

Patient-Friendly Collections

A collection approach that prioritizes respectful communication and flexible payment options.

Debt Settlement

An agreement to resolve a debt for less than the full amount owed.

Insurance Discovery

The process of identifying undisclosed or forgotten insurance coverage for a patient.

Coverage Identification

Determining whether a patient has active insurance coverage that can be billed.

Payer Discovery

The process of locating insurance carriers responsible for payment.

Coordination of Benefits (COB)

The process of determining which insurance plan is responsible for payment when multiple policies exist.

Primary Insurance

The insurance policy responsible for paying a claim first.

Secondary Insurance

An additional insurance policy that may cover remaining costs after the primary insurer.

Retroactive Coverage

Insurance coverage that applies to medical services provided before the insurance information was identified.

Claim Reprocessing

Resubmitting a claim to insurance after new coverage is discovered.

Payer

An insurance company or organization that pays healthcare claims.

Commercial Insurance

Health insurance plans provided by private companies.

Medicare

A federal health insurance program for individuals aged 65 and older or certain disabled individuals.

Medicaid

A government healthcare program providing coverage for individuals with limited income.

Out-of-Network

A provider that does not have a contract with a patient’s insurance plan.

In-Network Provider

A healthcare provider that has a contractual agreement with an insurance company.

Allowed Amount

The maximum amount an insurance company will pay for a covered service.

Prior Authorization

Approval required from an insurance company before certain treatments or procedures are performed.

Patient Financial Experience

The overall experience a patient has when interacting with healthcare billing and payment systems.

Financial Transparency

Providing patients with clear information about healthcare costs.

Payment Accessibility

Providing convenient ways for patients to submit payments.

Digital Billing

Electronic delivery of patient billing statements.

Patient Engagement

Communication strategies that help patients understand and resolve medical bills.

Admission Guidelines

Facility-specific clinical criteria used to determine whether a patient is appropriate for a procedure in an outpatient surgical setting.

AJRR (American Joint Replacement Registry)

A national database that tracks hip and knee replacement outcomes to support research, benchmarking, and quality improvement across surgical facilities.

Ambulatory Surgery Center (ASC)

A licensed healthcare outpatient facility where surgical procedures are performed on patients the same day.

Anesthesia Clearance

A preoperative review conducted by an anesthesiologist or CRNA confirming a patient is safe to undergo sedation or general anesthesia.

Automated Appointment Reminders

Digital messages that are pre-scheduled with automation software which are sent to patients via text or email to confirm upcoming procedures and reduce cancellations or no-shows.

Block Time

A recurring segment of operating room time reserved for a specific surgeon or surgical group.

BMI (Body Mass Index)

A measurement derived from a patient’s height and weight, often used in preoperative screening to assess anesthesia and surgical risk.

Case Cost

The process of calculating the total cost of supplies, staff time, and overhead associated with a single surgical procedure.

Clinical Documentation

The official record of a patient’s medical history, medications, exam findings, procedures performed, and care decisions.

Comorbidity

A pre-existing medical condition, such as diabetes or hypertension, that may affect surgical risk or recovery.

CPT Code (Current Procedural Terminology)

A standardized numeric code used to describe a specific medical or surgical service for billing purposes.

Day of Surgery or Date of Surgery (DOS)

The date on which a patient’s scheduled procedure takes place.

Digital Intake

The use of electronic forms and online tools that replaces paper-based processes to collect patient information before a procedure.

Digital Patient Engagement

The use of technology such as text messaging, email, and online portals to communicate with patients throughout their surgical journey.

Discharge Criteria

A set of clinical benchmarks a patient must meet before being released or discharged from a facility after a procedure has been successfully completed.

H&P (History and Physical)

A clinical document summarizing a patient’s medical history and physical examination, typically required within 30 days of a scheduled surgery.

HIPAA (Health Insurance Portability and Accountability Act)

Federal legislation that establishes standards for protecting patient health information and ensuring data privacy.

HOOS (Hip disability and Osteoarthritis Outcome Score)

A patient-reported questionnaire that measures hip pain, function, and quality of life before and after joint replacement surgery.

Informed Consent

A signed document confirming that a patient understands the risks, benefits, and alternatives of a proposed procedure and agrees to move forward.

Joint Commission (TJC)

An independent organization that accredits and certifies healthcare facilities based on quality and patient safety standards that they have established.

KOOS (Knee injury and Osteoarthritis Outcome Score)

A patient-reported questionnaire that measures knee pain, symptoms, and daily function before and after joint replacement surgery.

Length of Stay (LOS)

The total amount of hours a patient spends at a facility from admission to discharge.

Nil Per Os (NPO)

A Latin term meaning “nothing by mouth,” referring to the fasting instructions patients must follow before surgery to reduce aspiration risk.

No-Show Rate

The percentage of scheduled patients who fail to arrive for their procedure without prior cancellation.

Operating Room Utilization

A metric measuring how effectively a facility’s available surgical time is being used relative to its total capacity.

Patient-Reported Outcome Measure (PROM)

A standardized survey completed by patients to assess their own health status, pain levels, or functional ability before and after a procedure.

Patient Satisfaction Survey

A post-procedure questionnaire used to collect feedback on the patient’s experience, often tied to quality reporting and facility benchmarking.

Physician Preference Card

A document listing a surgeon’s preferred instruments, supplies, and setup requirements for a specific procedure.

Post-Op Communication

Outreach sent to patients to provide post-op recovery instructions, collect outcome data, or follow up on their experience.

Preoperative Assessment

A clinical evaluation conducted before surgery to review a patient’s health status and identify any conditions that may affect the procedure, anesthesia administration or patient safety.

Registry Reporting

The process of submitting clinical and outcome data to national registries like AJRR to meet quality benchmarks and support long-term research.

Same-Day Surgery

A surgical procedure in which the patient is admitted, undergoes the operation, and is discharged all within the same calendar day.

Scheduling Template

A configurable framework that defines available operating room time slots, room assignments, and surgeon block allocations.

Surgical Site Infection (SSI)

An infection that occurs at or near the incision site within 30 days of a surgical procedure. This is tracked as a key quality metric.

Turnaround Time

The interval between one surgical case ending and the next case beginning in the same operating room.