Medical Billing Terms D: Denial Management, Deductible and Days in A/R

Denial management is the process of tracking, correcting and preventing denied claims. This page defines it with the other terms from data retention to duplicate claim, including denial rate, days in A/R, deductible and downcoding. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms D: Denial Management - MCM South Medical Billing Service, LLC

Glossary pages

0-9 A B CDE F G H I J K-L M N-O P Q-R S T U-V W-Z

On this page (25 terms)

Data Retention
Date of Service (DOS)
Days in A/R
Days in Unbilled
DEA Registration
Deductible
Deemed Status
Delegated Credentialing
Denial Letter
Denial Management
Denial Prevention
Denial Rate
Dependent
Dependent Coverage to Age 26
Designated Record Set
Diagnosis Pointer
Diagnostic Evaluation (90791 / 90792)
Digital Mental Health Treatment
Distant Site
Documentation
Downcoding
DSM-5-TR
Dual Eligible
Dual Eligible Special Needs Plan (D-SNP)
Duplicate Claim

How to use these Denial Management definitions

Use this page as a quick reference for Denial Management, from Data Retention to Duplicate Claim. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Denial Management details with the payer before you bill.

Checklist: put the denial management definitions to work

Check the denial management entries above before you send a claim that depends on them.
Share this denial management page with front-desk and billing staff so everyone works from the same definitions.

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Data Retention

General (all payers)

Also called record retention; medical record retention

Definition: How long records must be kept, set by law, contracts, and payer rules, which vary.
Why it matters: Retention periods affect audits and disputes.
Illustrative example: A state sets a minimum retention period for records.

Reference sourceAHIMAchecked 10/9/26

CategoriesAudits & Compliance

Date of Service (DOS)

General (all payers)

Also called DOS; service date

Definition: The date the billed service was delivered.
Why it matters: It drives timely filing, eligibility, authorization, and coverage checks.
Illustrative example: A claim for a session on the 3rd must be filed within the payer's timely filing window from that date.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing

Days in A/R

General (all payers)

Also called days in accounts receivable; DAR; A/R days

Definition: A metric estimating how many days of average daily revenue are tied up in accounts receivable.
Why it matters: A high number signals slow collections or denial problems.
Illustrative example: A practice with $60,000 in A/R and $2,000 in daily charges has 30 days in A/R.

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

Days in Unbilled

General (all payers)

Also called unbilled days; unbilled A/R

Definition: The number of days of revenue for services delivered but not yet billed.
Why it matters: Shows the backlog before claims are sent.
Illustrative example: A practice has unbilled sessions from the last 10 days.

Related termsCharge Lag Days in A/R

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

DEA Registration

General (all payers)

Also called DEA number; DEA license

Definition: A registration from the Drug Enforcement Administration that allows prescribers to prescribe controlled substances.
Why it matters: Payers and pharmacies verify it, and it is part of credentialing for prescribers.
Illustrative example: A psychiatrist's DEA registration is listed in the credentialing file.

Related termsEPCS Credentialing

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesCredentialing & Enrollment Behavioral Health Specific Terms

Deductible

General (all payers)

Also called annual deductible; plan deductible

Definition: The amount a member pays for covered services before the plan starts paying, for services that are subject to the deductible.
Why it matters: Explains why early-year visits often have higher patient balances.
Illustrative example: A patient with a $1,500 deductible pays the allowed amount until it is met.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPatient Financial Responsibility Terms Eligibility & Benefits

Deemed Status

Medicare

Also called deemed status; deeming authority; CMS deemed accreditation

Definition: Deemed status is when CMS accepts accreditation from an approved accrediting organization as evidence that a provider meets Medicare conditions, in place of a state survey, for certain provider types.
Why it matters: It applies to certain provider types and programs, not to most independent behavioral health practices. Check whether your provider type is affected.
Illustrative example: A hospital's Joint Commission accreditation gives it deemed status for Medicare participation.

Reference sourceThe Joint Commission CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesQuality & Risk Adjustment Terms Medicare & Medicaid Terms

Delegated Credentialing

General (all payers)

Also called delegation agreement

Definition: An arrangement in which a payer lets another organization, such as a large group or IPA, perform credentialing on its behalf under agreed standards.
Why it matters: It can shorten enrollment for clinicians inside a delegated group, but it requires audits and oversight.
Illustrative example: A large group with a delegation agreement credentials its own clinicians for a payer.

Related termsCredentialing NCQA Group Enrollment

Reference sourceNCQAchecked 10/9/26

CategoriesCredentialing & Enrollment Contracting & Network Management

Denial Letter

General (all payers)

Also called adverse benefit determination; notice of denial

Definition: A written notice explaining a denial, including reasons, appeal rights, and deadlines.
Why it matters: The letter is the source for appeal deadlines and required documents.
Illustrative example: A biller logs the date and appeal deadline from each letter.

Reference sourceCMS (Centers for Medicare & Medicaid Services)U.S. Department of Labor, EBSAchecked 10/9/26

CategoriesDenials & Appeals

Denial Management

General (all payers)

Also called denial workflow; denial follow-up

Definition: A process for tracking, categorizing, fixing, and preventing denials.
Why it matters: Good denial management raises first-pass resolution and cuts write-offs.
Illustrative example: A biller works denial reports weekly, by reason code and payer.

Reference sourceHFMAchecked 10/9/26

CategoriesDenials & Appeals Revenue Cycle Metrics

Denial Prevention

General (all payers)

Also called front-end denial prevention

Definition: Process steps that stop denials before they happen, such as eligibility checks, authorization tracking, and claim scrubbing.
Why it matters: Preventing denials costs less than appealing them.
Illustrative example: A practice adds a required eligibility check to intake.

Reference sourceHFMAchecked 10/9/26

CategoriesDenials & Appeals Revenue Cycle Metrics

Denial Rate

General (all payers)

Also called claim denial rate; initial denial rate

Definition: The percentage of submitted claims that are denied, often measured by count or dollar amount.
Why it matters: Rising rates point to front-end or payer problems.
Illustrative example: A practice sees 8% of claims denied initially.

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics Denials & Appeals

Dependent

General (all payers)

Also called covered dependent; patient relationship

Definition: A person covered under another person's plan, such as a spouse or child.
Why it matters: Dependent info errors (birth date, relationship) reject claims.
Illustrative example: A child is covered under a parent's plan.

Related termsSubscriber Member ID

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesEligibility & Benefits

Dependent Coverage to Age 26

General (all payers)

Also called adult child coverage; young adult on parent's plan; ACA dependent coverage

Definition: Dependent coverage to age 26 is a federal Affordable Care Act rule that requires health plans that offer coverage for children to keep making it available to an adult child until age 26.
Why it matters: A young adult can be over the age of majority and still be a dependent on a parent's plan. The parent is the subscriber, the patient is the adult decision-maker, and statements can go to the wrong person. Verify the plan's rules, and use a confidential communications request when needed.
Illustrative example: A 22-year-old is a patient and a dependent on her father's plan. Her EOBs go to her father, so she asks to receive communications at her own address.

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesEligibility & Benefits Patient Financial Responsibility Terms

Designated Record Set

General (all payers)

Also called DRS; designated record set HIPAA; medical and billing records

Definition: A designated record set is the group of records a covered entity keeps that are used to make decisions about an individual. It includes medical and billing records, and it defines what a patient can access or ask to amend under HIPAA.
Why it matters: Know what is in it before you answer a records request. Psychotherapy notes kept separately are not part of it.
Illustrative example: A practice decides that the chart, the intake forms, and the billing ledger are part of the designated record set, and keeps separate psychotherapy notes out of it.

Reference sourceHHS (U.S. Department of Health and Human Services)HHS Office for Civil Rights (OCR)checked 10/9/26

CategoriesAudits & Compliance

Diagnosis Pointer

General (all payers)

Also called dx pointer; diagnosis pointer letter

Definition: The field on a service line that links the procedure to one or more diagnoses on the claim.
Why it matters: A missing or wrong pointer can cause rejections or denials.
Illustrative example: Line 1 points to diagnosis A, the primary diagnosis.

Reference sourceNUCCchecked 10/9/26

CategoriesClaims Processing EDI & Clearinghouse Terms

Diagnostic Evaluation (90791 / 90792)

General (all payers)

Also called 90791; 90792; psychiatric diagnostic evaluation; intake evaluation

Definition: CPT codes for a psychiatric diagnostic evaluation: 90791 without medical services and 90792 with medical services, generally used by prescribers.
Why it matters: Determines the correct intake code for therapists versus psychiatrists.
Illustrative example: A therapist bills 90791 for an intake; a psychiatrist bills 90792.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesClaims Processing Behavioral Health Specific Terms

Digital Mental Health Treatment

General (all payers)

Also called DMHT; digital therapeutics

Definition: Use of software-based or digital tools as part of behavioral health treatment, with emerging billing codes in some programs.
Why it matters: Coverage is evolving and payer-specific.
Illustrative example: A payer covers a digital treatment device under a specific code.

Related termsTelehealth AI Scribe

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesTelehealth Terms AI & Healthcare Automation Terms

Distant Site

General (all payers)

Also called provider site; telehealth distant site

Definition: The location of the clinician furnishing a telehealth service.
Why it matters: Some payers require the clinician's location to be reported or restricted.
Illustrative example: A therapist provides sessions from a home office.

Related termsOriginating Site Telehealth

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesTelehealth Terms Medicare & Medicaid Terms

Documentation

General (all payers)

Also called clinical documentation; documentation requirements

Definition: The clinical record that shows what service was provided, when, for how long, and why, in support of the claim.
Why it matters: Good documentation is the best defense in audits and appeals.
Illustrative example: A note records date, start and end times, diagnosis, intervention, and plan.

Reference sourceAHIMAchecked 10/9/26

CategoriesAudits & Compliance Behavioral Health Specific Terms

Downcoding

General (all payers)

Also called payer downcoding; code downgrade

Definition: A payer's change of the billed code to a lower-paying code, often for time or level of service reasons.
Why it matters: Contracts may allow downcoding under policy; documentation is the main defense.
Illustrative example: A payer pays a 90834 rate for a claim billed as 90837.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesDenials & Appeals

DSM-5-TR

General (all payers)

Also called DSM; Diagnostic and Statistical Manual of Mental Disorders

Definition: The American Psychiatric Association's manual for diagnosing mental disorders. Clinicians diagnose with the DSM, and claims carry the matching ICD-10-CM code.
Why it matters: Clinical diagnoses must be translatable to billable ICD-10-CM codes.
Illustrative example: A therapist documents a DSM-5-TR diagnosis and codes it on the claim in ICD-10-CM.

Reference sourceAmerican Psychiatric Associationchecked 10/9/26

CategoriesBehavioral Health Specific Terms Claims Processing

Dual Eligible

General (all payers)

Also called dually eligible; Medicare-Medicaid enrollee; dual-eligible beneficiary

Definition: A person enrolled in both Medicare and Medicaid.
Why it matters: Billing sequence, payment limits, and crossover rules are specific to dual eligibles.
Illustrative example: A patient with Medicare and Medicaid receives therapy; Medicare pays first.

Reference sourceCMS (Centers for Medicare & Medicaid Services)Medicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms Eligibility & Benefits

Dual Eligible Special Needs Plan (D-SNP)

Medicare and Medicaid

Also called D-SNP; dual special needs plan; Medicare Medicaid dual plan

Definition: A dual eligible special needs plan is a Medicare Advantage plan for people who qualify for both Medicare and Medicaid. It coordinates benefits for those members.
Why it matters: Billing can involve Medicare, the plan, and the state Medicaid program. Check who pays what, and how the plan handles cost sharing that Medicaid covers.
Illustrative example: A patient with both Medicare and Medicaid enrolls in a D-SNP, so the biller checks how the plan handles cost sharing before billing.

Reference sourceCMS (Centers for Medicare & Medicaid Services)Medicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms BCBS, UHC & Commercial Payer Terms

Duplicate Claim

General (all payers)

Also called duplicate claim denial

Definition: A claim that repeats one the payer already has, often triggering a denial.
Why it matters: Resubmitting an unpaid claim without checking status is a common cause.
Illustrative example: A practice resubmits a claim still in process and receives a duplicate denial.

Related termsClaim Status Corrected Claim

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing Denials & Appeals

Quick answer: Denial Management

What is denial management?

Denial Management is a process for tracking, categorizing, fixing, and preventing denials. Good denial management raises first-pass resolution and cuts write-offs.

Frequently asked questions: Denial Management

What are days in A/R?

Days in A/R is a metric estimating how many days of average daily revenue are tied up in accounts receivable. A high number signals slow collections or denial problems.

What is a deductible?

Deductible is the amount a member pays for covered services before the plan starts paying, for services that are subject to the deductible. Explains why early-year visits often have higher patient balances.

What is downcoding?

Downcoding is a payer's change of the billed code to a lower-paying code, often for time or level of service reasons. Contracts may allow downcoding under policy; documentation is the main defense.

Related resources

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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