Accounts receivable (AR) in healthcare are reimbursements or invoices owed to a hospital, medical practice, or other healthcare organizations by patients or healthcare plans.

Adjudication is the vital process where a payer reviews a submitted healthcare claim and determines its validity, compliance, and the reimbursement amount owed to a provider. It directly influences whether claims are paid, denied, or partially approved, shaping revenue cycles for healthcare organizations.

Administrative denial is a specific category of claim denial in healthcare revenue cycle management (RCM) whereby a payer denies a submitted claim based on non-clinical or procedural reasons over medical necessity or quality of care. Administrative or technical mistakes are the basis for such denials, and they usually block the claim from proceeding to additional clinical review or payment.

The Advance Beneficiary Notice of Noncoverage (ABN) is a form (CMS-R-131) that helps Medicare Fee-for-Service (FFS) patients make informed decisions. ABN informs them about items and services that may not be covered in specific situations.

Allowable charge is a basic concept in healthcare revenue cycle management (RCM), which is the maximum a payer, such as insurance organization or government program, is prepared to pay for a specific medical service or procedure. It is set ahead of time through fee schedules, agreements, and payer-provider negotiations to standardize how charges are reimbursed throughout the healthcare environment.

An Alternative Payment Model (APM) is a value-based reimbursement approach designed to promote high-quality, cost-efficient care by offering incentive payments. APMs apply to specific clinical conditions, patient populations, or care episodes, shifting away from traditional fee-for-service models by using bundled payments and care coordination methods.

Ambulatory Payment Classification (APC) is the method the government uses to pay facilities for outpatient services through the Medicare program.

An Assignment of Benefits (AOB) is a contractual arrangement where a patient grants permission for their healthcare provider to be paid directly by their health insurance company for covered medical services.

An audit in healthcare revenue cycle management (RCM) is a routine, organized assessment of an entity's financial reports, coding integrity, and compliance standards. Audits are essential in ensuring that healthcare providers have transparent operations, adhere to regulations, and embrace best practices in billing, coding, and documentation.