Healthcare reimbursements incorporate the process of compensating providers or physicians for the care provided by insurance payers.

Relative Weight (RW) is a standardized metric used in healthcare reimbursement systems to indicate the relative intensity, cost, and resource utilization of treating patients within a specific Diagnosis-Related Group (DRG) or Ambulatory Payment Classification (APC).

Remittance Advice (RA) is a detailed document issued by a health insurance company or third-party payer to a healthcare provider, explaining how submitted claims were processed. It outlines whether claims were paid in full, partially paid, or denied, and provides reasons for adjustments, denials, or rejections.

A revenue code is a numeric code that is used in medical billing. It indicates the type of service or department that provided care to a patient. It is also assigned on the UB-04 (CMS-1450) claim form and helps payers gain clarity about the services rendered and other associated details.

Explore how revenue cycle flowchart helps streamline processes, improves collaboration, and clarifies interdependencies.

Looking for detailed information on healthcare RCM? This comprehensive guide has everything you need to know about revenue cycle management.

Learn how automation in RCM can improve efficiency and productivity for healthcare providers in this guide.

Learn everything about outsourcing RCM in this guide. Healthcare providers get answers to all their questions.

Single-Path Coding is an approach to revenue cycle management where a single coder performs both the facility and professional coding on the same patient encounter in a single workflow.

A single-payer health system is a healthcare financing model where one entity, typically the government, is responsible for collecting healthcare funds and paying for services for the entire population. It aims to ensure universal access to medical care while streamlining costs and administration.

A skilled nursing facility (SNF) is a licensed healthcare center that provides short-term medical care and rehabilitation for patients recovering from a hospital stay or needing continuous supervision beyond what can be handled at home.

The Social Insurance (Bismarck) Model is a healthcare financing system based on solidarity and shared risk. It is funded through employer and employee contributions paid into non-profit insurance funds, which provide universal coverage while care is delivered by private providers under centralized regulation.

The Social Security Act is a landmark federal law enacted in 1935 that established a framework for social insurance and income security programs in the United States, providing crucial benefits to the elderly, disabled, and vulnerable populations through a foundation of government-administered support.

A sole-community hospital (SCH) is the sole provider of inpatient hospital services within a particular geographic region, frequently in rural or isolated areas. Identified and shielded by federal policy, SCHs are vital to the preservation of the health of populations that otherwise would have their access to medical services severely impaired.

A Summary of Benefits and Coverage (SBC) is a legally mandated document under the Affordable Care Act that describes the important information of a health insurance plan. It provides a clear summary of what is covered, how much it costs, and what restrictions apply, so that individuals and employers can make comparisons and make well-informed decisions about coverage.

In healthcare, a third-party payer refers to any public or private entity, such as an insurance company, government program, or managed care organization, that assumes financial responsibility for covering some or all of a patient’s medical costs.

A tier is a designated category within the revenue cycle that organizes patient accounts or billing items by criteria such as risk, dollar value, or claim complexity, ensuring focused management and tailored operational strategies.

Unbundling in healthcare refers to the process of separating and billing different healthcare service components that are bundled together.

Utilization review is the process healthcare teams and payers use to check whether a service is medically necessary, appropriate, and efficient. It can happen before care, while treatment is underway, or after discharge.

The Veterans Health Administration (VHA) is the largest government agency that offers specialized care, primary care, and related social and medical support services to the U.S. veterans.

The waiting period in healthcare is the duration for which you have to wait before getting benefits, which begins from the date of policy commencement.