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

Discover what administrative denials are, their causes, and how they differ from medical necessity denials. Learn through examples like coding errors and incomplete claims.

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.

The allowable charge is the highest amount a health insurance payer will reimburse for a specific medical procedure.

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.