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Billing Terms Glossary
Revenue Cycle Metrics: Definitions for Therapists and Psychiatrists
In this section
- 27 terms defined
- Written for psychotherapists and psychiatrists
- Source organization linked on every entry
A/R Aging
General (all payers)Also called: aging report; A/R aging buckets; 0-30 31-60 61-90 90+
- Definition
- A report that groups unpaid claims by how long they have been outstanding, typically in 30-day buckets.
- Why it matters
- Older buckets are harder to collect and show where follow-up is needed.
- Illustrative example
- A biller works the 61 to 90 day bucket weekly.
Related terms Accounts Receivable (A/R)Days in A/RA/R Follow-Up
Reference source HFMA
Categories Revenue Cycle Metrics
A/R Follow-Up
General (all payers)Also called: accounts receivable follow-up; claim follow-up; follow-up
- Definition
- The routine work of checking unpaid claims, contacting payers, and resolving problems until claims are paid or closed.
- Why it matters
- Regular follow-up is how unpaid claims are caught before timely filing runs out.
- Illustrative example
- A biller works claims older than 30 days by payer every week.
Related terms A/R AgingClaim StatusTimely Filing
Reference source HFMA
Categories Revenue Cycle MetricsClaims Processing
Accounts Receivable (A/R)
General (all payers)Also called: AR; A/R; accounts receivable
- Definition
- The money owed to a practice for services already delivered, from payers and patients.
- Why it matters
- A/R age and size show cash flow health.
- Illustrative example
- A practice has $40,000 in outstanding claims and balances.
Related terms Days in A/RA/R AgingNet Collection Rate (NCR)
Reference source HFMA
Categories Revenue Cycle Metrics
Appeal Success Rate
General (all payers)Also called: overturn rate; appeal overturn rate
- Definition
- The percentage of appealed claims that are reversed in the provider's favor.
- Why it matters
- Shows whether appeal effort is paying off.
- Illustrative example
- A practice wins 60% of its medical necessity appeals.
Related terms AppealDenial Rate
Reference source HFMA
Categories Revenue Cycle MetricsDenials & Appeals
Cancellation Rate
General (all payers)Also called: late cancellation rate
- Definition
- The percentage of appointments canceled, including short-notice cancellations.
- Why it matters
- Shows schedule stability.
- Illustrative example
- A practice tracks late cancels by clinician.
Related terms No-Show RateUtilization Rate
Reference source MGMA
Categories Revenue Cycle Metrics
Charge Capture
General (all payers)Also called: missed charges; charge reconciliation
- Definition
- Ensuring all delivered services are recorded and billed.
- Why it matters
- Missed charges are lost revenue.
- Illustrative example
- A biller reconciles the schedule with submitted claims.
Related terms Revenue LeakageCharge Lag
Reference source HFMA
Categories Revenue Cycle Metrics
Charge Lag
General (all payers)Also called: days to charge entry; charge entry lag
- Definition
- The time between the date of service and when the charge is entered in the billing system.
- Why it matters
- Long lag delays billing and raises timely filing risk.
- Illustrative example
- A therapist finalizes notes five days after sessions.
Related terms Days in UnbilledTimely Filing
Reference source HFMA
Categories Revenue Cycle Metrics
Clean Claim Rate
General (all payers)Also called: clean claim percentage
- Definition
- The percentage of claims accepted and processed on first submission without needing correction.
- Why it matters
- Shows the quality of front-end processes.
- Illustrative example
- A practice sees 95% of claims accepted without correction.
Related terms First Pass Resolution Rate (FPRR)Claim ScrubbingClean Claim
Reference source HFMA
Categories Revenue Cycle MetricsClaims Processing
Cost to Collect
General (all payers)Also called: cost of billing; billing cost percentage
- Definition
- The cost of billing and collections as a percentage of revenue collected.
- Why it matters
- Helps compare in-house and outsourced billing.
- Illustrative example
- A practice spends 7 cents to collect each dollar.
Related terms Revenue Cycle Management (RCM)Net Collection Rate (NCR)
Reference source HFMA
Categories Revenue Cycle Metrics
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.
Related terms Accounts Receivable (A/R)A/R AgingNet Collection Rate (NCR)
Reference source HFMA
Categories Revenue 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 terms Charge LagDays in A/R
Reference source HFMA
Categories 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.
Related terms Denial ManagementRoot Cause AnalysisFirst Pass Resolution Rate (FPRR)
Reference source HFMA
Categories Revenue Cycle MetricsDenials & Appeals
FinThrive
General (all payers)Also called: FinThrive revenue cycle
- Definition
- A revenue cycle technology and services vendor for health care providers. Listed for reference; not an endorsement or partnership.
- Why it matters
- Appears among revenue cycle vendors, mainly for larger organizations.
- Illustrative example
- A health system uses FinThrive for revenue integrity.
Verify: confirm current offerings.
Related terms Revenue Cycle Management (RCM)Revenue Integrity Solution
Reference source FinThrive
Categories Revenue Cycle Metrics
First Pass Resolution Rate (FPRR)
General (all payers)Also called: FPRR; first pass rate; first-pass acceptance rate
- Definition
- The percentage of claims paid on first submission without rework, denial, or appeal.
- Why it matters
- Higher FPRR means less rework and faster cash.
- Illustrative example
- A practice tracks FPRR by payer each month.
Related terms Clean Claim RateDenial RateClaim Scrubbing
Reference source HFMA
Categories Revenue Cycle MetricsClaims Processing
Gross Collection Rate (GCR)
General (all payers)Also called: GCR; gross collection percentage
- Definition
- The percentage of total billed charges that a practice collects, before adjusting for contractual write-offs.
- Why it matters
- Less meaningful than net collection rate because it includes write-offs.
- Illustrative example
- A practice collects 60% of gross charges.
Related terms Net Collection Rate (NCR)Billed Charge
Reference source HFMA
Categories Revenue Cycle Metrics
HFMA (Healthcare Financial Management Association)
General (all payers)Also called: HFMA
- Definition
- A professional association for healthcare finance leaders that publishes revenue cycle guidance and metric definitions.
- Why it matters
- Common reference for revenue cycle metrics such as days in A/R.
- Illustrative example
- A manager uses HFMA definitions for KPI reports.
Related terms Revenue Cycle Management (RCM)Days in A/R
Reference source HFMA
Categories Revenue Cycle Metrics
Key Performance Indicator (KPI)
General (all payers)Also called: KPI; billing KPI
- Definition
- A measurable value that shows how well a process is performing against a goal.
- Why it matters
- Consistent KPIs make trends visible.
- Illustrative example
- A billing dashboard tracks denial rate and days in A/R.
Related terms Days in A/RDenial Rate
Reference source HFMA
Categories Revenue Cycle Metrics
Medical Billing Company
General (all payers)Also called: billing service; outsourced billing; third-party billing
- Definition
- A company that handles billing and collections for practices under a services contract, and that is a business associate under HIPAA.
- Why it matters
- Requires a BAA and clear expectations on reporting, access, and payment flow.
- Illustrative example
- A practice outsources claims, follow-up, and denials to a billing company.
Related terms Business Associate Agreement (BAA)Revenue Cycle Management (RCM)
Reference source HHS (U.S. Department of Health and Human Services) · HHS Office for Civil Rights (OCR)
Categories Revenue Cycle MetricsAudits & Compliance
MGMA (Medical Group Management Association)
General (all payers)Also called: MGMA
- Definition
- A professional association for medical practice administrators that publishes benchmarking data and practice management resources.
- Why it matters
- A source for practice operations benchmarks.
- Illustrative example
- A practice compares its metrics to MGMA benchmarks.
Related terms Productivity MetricsPayer Mix
Reference source MGMA
Categories Revenue Cycle MetricsMedicare & Medicaid Terms
Net Collection Rate (NCR)
General (all payers)Also called: NCR; net collection percentage
- Definition
- The percentage of collectible revenue, after contractual adjustments, that a practice actually collects.
- Why it matters
- A core measure of billing performance.
- Illustrative example
- A practice collects $9,600 of $10,000 in collectible revenue: 96%.
Related terms Gross Collection Rate (GCR)Contractual AdjustmentDays in A/R
Reference source HFMA
Categories Revenue Cycle Metrics
No-Show Rate
General (all payers)Also called: missed appointment rate
- Definition
- The percentage of scheduled appointments that patients miss without notice.
- Why it matters
- Directly affects revenue and schedule use.
- Illustrative example
- A practice sees 6% no-shows.
Related terms Cancellation RateNo-Show Fee
Reference source MGMA
Categories Revenue Cycle Metrics
Patient A/R
General (all payers)Also called: patient accounts receivable; patient balances
- Definition
- The portion of receivables owed by patients rather than payers.
- Why it matters
- Grows with high-deductible plans and needs its own workflow.
- Illustrative example
- A practice separates payer and patient A/R in reports.
Related terms Accounts Receivable (A/R)Patient Responsibility
Reference source HFMA
Categories Revenue Cycle Metrics
Payer Mix
General (all payers)Also called: payer mix analysis; revenue by payer
- Definition
- The distribution of a practice's revenue or visits by payer or payer type.
- Why it matters
- Payer mix affects average reimbursement and risk.
- Illustrative example
- A practice gets 60% of revenue from commercial and 20% from Medicaid.
Related terms Fee ScheduleContracted Rate
Reference source HFMA
Categories Revenue Cycle Metrics
Productivity Metrics
General (all payers)Also called: clinician productivity; wRVU productivity
- Definition
- Measures of how much billable work a clinician delivers, such as sessions, units, or work RVUs.
- Why it matters
- Used for compensation and capacity planning.
- Illustrative example
- A group tracks sessions per week per clinician.
Related terms Relative Value Unit (RVU)Utilization Rate
Reference source MGMA
Categories Revenue Cycle Metrics
Revenue Cycle Management (RCM)
General (all payers)Also called: RCM; revenue cycle; medical billing revenue cycle
- Definition
- The end-to-end process of managing patient access, billing, payment, and follow-up, from scheduling and eligibility through final payment and patient collections.
- Why it matters
- Understanding each step helps find where revenue leaks.
- Illustrative example
- A practice tracks each claim from intake to payment.
Related terms Days in A/RNet Collection Rate (NCR)First Pass Resolution Rate (FPRR)
Reference source HFMA
Categories Revenue Cycle Metrics
Revenue Leakage
General (all payers)Also called: missed revenue; lost revenue
- Definition
- Revenue lost through missed charges, denials, underpayments, late filing, or unbilled services.
- Why it matters
- Systematic review finds recoverable money.
- Illustrative example
- A practice discovers unbilled sessions from a miscommunication.
Related terms Charge CaptureUnderpaymentTimely Filing
Reference source HFMA
Categories Revenue Cycle Metrics
Utilization Rate
General (all payers)Also called: clinician utilization; schedule fill rate
- Definition
- The share of available appointment slots that are filled with billable sessions.
- Why it matters
- Ties capacity to revenue.
- Illustrative example
- A therapist fills 25 of 30 weekly slots.
Related terms No-Show RateProductivity Metrics
Reference source MGMA
Categories Revenue Cycle Metrics
More billing terms
- Credentialing & Enrollment 58
- Contracting & Network Management 22
- Claims Processing 172
- Eligibility & Benefits 75
- Payment & Reimbursement 61
- Denials & Appeals 46
- Audits & Compliance 115
- Behavioral Health Specific Terms 148
- CPT, E/M & HCPCS Code Entries 54
- Telehealth Terms 23
- EDI & Clearinghouse Terms 63
- BCBS, UHC & Commercial Payer Terms 54
- Medicare & Medicaid Terms 145
- Value-Based Care Terminology 23
- Prior Authorization Terminology 22
- Quality & Risk Adjustment Terms 34
- EHR & Healthcare Technology Terms 54
- Provider Data Management Terms 26
- Patient Financial Responsibility Terms 35
- AI & Healthcare Automation Terms 12
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