Acronyms of Revenue Cycle Management

Revenue cycle management (RCM) involves the oversight and execution of many of the non-clinical operations supporting patient care. It also involves interactions with various public and private entities. Acronyms help distinguish these topics and organizations. Understanding who and what these acronyms represent can help when communicating with revenue cycle management consulting partners like us here at Physician Practice Specialists.

Healthcare Operations 

Our team offers RCM services to enhance medical practices’ financial health. By analyzing data and trends, our consultants develop tailored strategies to optimize revenue generation and cash flow. We can conduct thorough assessments of revenue cycles, identifying bottlenecks and areas for improvement. Some common acronyms related to healthcare operations within the revenue cycle include:

Electronic Data Interchange (EDI): Standardized format for the electronic exchange of information between different healthcare organizations.

Health Insurance Portability and Accountability Act (HIPAA): Federal legislation regulating patient medical information privacy.

Practice Management System (PMS): Software tools that manage a healthcare practice’s billing and administrative tasks. 

Electronic Health Record (EHR): Comprehensive medical history of a particular patient across various healthcare organizations and providers. 

Electronic Medical Record (EMR): Digital copies of a patient’s clinical documentation related to individual episodes of care.

Insurance Providers 

RCM consultants assist healthcare practices in their interactions with insurance providers. Our services cover credentialing, contracting, and compliance adherence. Here are several acronyms describing different public and private insurance providers: 

Centers for Medicare and Medicaid Services (CMS): Federal agency that administers national Medicare and Medicaid programs.

Medicare Administrative Contractor (MAC): Private health insurers given regional jurisdiction to process Medicare claims.

Recovery Audit Contractor (RAC): CMS-commissioned contractors tasked with recovering improper payments paid under Medicare.

Health Maintenance Organization (HMO): Private insurance plans limiting coverage to contracted facilities and providers. 

Preferred Provider Organization (PPO): Insurance plans allowing for care from any provider, with lower costs offered for services rendered by preferred providers. 

Coding and Billing 

Consultants provide valuable coding and billing assistance to medical practices, promoting accuracy and efficiency. We can help with claims submission, tracking, and denial management. The acronyms covering coding and billing concepts are as follows:

Service Type Code (STC): Codes identifying the category of care rendered to a patient.

International Classification of Diseases (ICD-10): International coding system describing medical diagnoses. The “10” indicates the tenth revision currently being used. 

Current Procedural Terminology (CPT): Numerical codes assigned by the American Medical Association (AMA) describing surgical and diagnostic procedures. 

Healthcare Common Procedure Coding System (HCPCS): Alphanumeric identifiers describing procedures and equipment not covered by CPT codes. 

National Correct Coding Initiative (NCCI): Methodologies dictating the proper coding of related medical services. 

Coverage and Reimbursement

Before rendering services, providers can verify patient insurance coverage and procedure authorization to make sure they will receive reimbursement. RCM consultants implement systems and processes that assist with this verification process. The following acronyms are associated with reimbursement for services: 

Relative Value Units (RVUs): Weights assigned to the clinical effort expended during medical procedures. These are used to calculate reimbursement for services.

Local Coverage Determination (LCD): Policies issued by a regional MAC determining which medical services are covered.

Medicare Physician Fee Schedule (MPFS): Designated payments for physician services (as determined by CMS). 

Multiple Procedure Payment Reduction (MPPR): Reduced payment for procedures deemed secondary to a primary procedure performed during the same encounter.

Medically Unlikely Edit (MUE): Maximum number of units of a particular service allowed to be billed to a single patient on the same service date.

Revenue Cycle Management Consulting

RCM uses a unique language for healthcare, insurance, and billing communications. A better understanding of each concept introduces increased efficiency into a clinic or provider’s everyday operations. Our knowledgeable team of revenue cycle management consulting professionals can complement your practice, providing expertise and comprehensive RCM support. Contact Physician Practice Specialists today to learn more about the management and consulting services we offer.