Administrative Terms, Acronyms, and Billing Standards
Welcome to the Integral Clinic Solutions Medical Practice Management Glossary. Navigating independent healthcare administration requires absolute clarity.
Use this index to find clear, operational definitions for complex provider credentialing acronyms, revenue cycle management (RCM) workflows, and medical billing compliance standards.
- 25 Modifier
- 60-Day Rule
- 837 File
- 837P
- Absent Physician
- Access Audit
- Access Manager (AM)
- Access Review
- Accounts Receivable (AR)
- Accounts Receivable Follow-Up
- Accounts Receivable Management
- Accreditation
- ACH Payment
- ADA Compliance
- Admitting Privileges
- Admitting Privileges
- Allowable Amount
- AMA CME Training
- Ambulatory Surgery Center (ASC)
- Ancillary Services
- API Validation Drop
- Attribution (Patient Attribution)
- Audio-Only Telehealth
- Audit
- Audit Trail
- Auth Number
- Authorization Coordinator
- Authorization Number
- Auto-Renewal (Virtual Address Subscriptions)
- Behavioral Health Telehealth
- Better Business Bureau (BBB)
- Bundled Procedures
- Bundled Services
- Bundling
- Business Continuity Protocols
- Business Function Approval
- Business Registration Address
- CAQH ProView
- Care Gap
- Cash Flow Forecasting
- Certificate of Completion
- Certificate of Medical Necessity (CMN)
- Charge Capture
- Charge Lag
- Chronic Care Management
- Chronic Care Management (CCM)
- Claim Adjudication
- Claim Denial Reason
- Claim Lifecycle
- Claims Appeal
- Claim Scrubbing
- Claim Status Tracking
- Claims Transmission
- Clean Claim
- Clean Claim Rate
- Clean Claims
- Clearinghouse
- Clearinghouse Rejection
- CLIA
- CLIA Certificate of Waiver
- CLIA Number
- CLIA-Waived Testing
- Clinical Documentation
- Clinical Documentation Improvement (CDI)
- Clinical Documentation Query
- Clinical Quality Measure (CQM)
- CMS-1500 Form
- CMS Identity and Access Management System (CMS I&A)
- Code Set Update
- Code Specificity
- Code Validation
- Coding Audit
- Coding Compliance
- Coding Reference Tool
- Commercial Insurance
- Community Care Network (CCN)
- Compliance Changes
- Compliance Risk
- Comprehensive Clearinghouse
- Connection Request
- Consolidated Billing
- Continued Need / Continued Use
- Continuing Medical Education
- Continuity of Care
- Contracting
- Contract Participation
- Contract Termination Notice
- Controlled Substance CME
- Controlled Substance Prescribing Authority
- Controlled Substances
- Coordination of Benefits
- Council for Affordable Quality Healthcare (CAQH)
- Courtesy Privileges
- Coverage Timeline
- Coverage Window
- CPT
- CPT Code
- CPT Codes
- CPT Modifier
- CPT Modifier 25
- CPT Modifiers
- Credentialed Provider
- Credentialing
- Credentialing Committee
- Credentialing Packet
- Credentialing Process (Military Insurance)
- Credentialing Vendor
- Credentialing Verification Organization (CVO)
- Credentialing Workflow
- Cross-Training
- Cybersecurity Threats
- DATA-Waiver
- Days in A/R
- DEA 8-Hour Rule
- DEA 8-Hour Training
- DEA 8-Hour Training Requirement
- DEA CME Requirement
- DEA Diversion Control Division
- DEA Education Mandate
- DEA License
- DEA License Renewal
- DEA Opioid Training
- DEA Registration
- DEA Renewal
- DEA Renewal Checklist
- DEA Training Certificate
- Deductible Season
- Delegated Official (DO)
- Denial Code
- Denial Management
- Denial Rate
- Denials
- Diagnosis Code
- Diagnosis Sequencing
- Diagnosis-to-Procedure Linking
- Durable Medical Equipment (DME)
- Early Intervention
- EDI Enrollment
- Edit Code
- Edit Rules
- EFT (Electronic Funds Transfer)
- EFT Enrollment
- EHR (Electronic Health Record)
- EHR Referral Modules
- Electronic Data Interchange (EDI)
- Electronic Funds Transfer (EFT)
- Electronic Medical Record (EMR)
- Electronic Prescriptions for Controlled Substances
- Electronic Remittance Advice (ERA)
- Electronic Tracking Systems
- Eligibility Failure
- Eligibility Verification
- EMR Tracking Tools
- End-Stage Renal Disease (ESRD) Dialysis Telehealth
- End User Staff
- EOB
- EOB Code
- ERA (Electronic Remittance Advice)
- ERA Enrollment
- Exclusion Monitoring
- Expiration Date (Drug/Vaccine)
- Explanation of Benefits (EOB)
- External User Services (EUS) Help Desk
- Facility RVU
- False Claims Act
- Fee-For-Service Fee-Time Compensation Arrangement
- Fee-for-Service (FFS)
- Fee Schedule
- Fee Schedule Setup
- First-Pass Denial Rate
- Follow-Up Strategy
- Gross Production
- Group Affiliation
- Group Contract
- Group NPI
- HCPCS Codes
- HCPCS Level II Codes
- HCPCS Unit
- Healthcare Reputation Management
- Healthcare Survey Tools
- Health Professional Shortage Area (HPSA)
- HEDIS Measures
- Hidden Fees
- Hierarchical Condition Category (HCC)
- High-Deductible Health Plan (HDHP)
- HIPAA
- HIPAA Compliance
- HIPAA‑Compliant
- HIPAA Compliant Virtual Mailbox
- Hospitalist
- Hospital Privileges
- ICD10
- ICD-10-CM
- ICD-10 Codes
- Incentive Payments
- Incident-To Billing
- Independent Medical Practice
- Individualized Quality Control Plan
- Individual NPI
- In-Network Provider
- Insurance Credentialing
- Insurance Explanation
- Insurance Network
- Insurance Policy Rules
- Insurance Verification
- J-Code(s)
- Key Performance Indicators (KPI)
- Labeler Code (NDC)
- LCD (Local Coverage Determination)
- Licensed Independent Practitioner (LIP)
- Locum Tenens
- Lot Number
- Malpractice History Review
- Managed Care Contract
- Managed Care Contracting
- Master Portal Administrator
- MATE Act
- MAT Waiver
- Medicaid
- Medicaid Managed Care
- Medical Billing Clearinghouse
- Medical Executive Committee (MEC)
- Medical Necessity
- Medical Staff Committee
- Medical Staff Privileges
- Medicare Advantage
- Medicare Enrollment
- Medicare Final Rule 2026
- Medicare Reassignment
- Medication-Assisted Treatment
- Military Insurance
- Moderate-Complexity Testing
- Modifier 25
- Modifier 95
- Modifier Q5
- Modifier Q6
- Multi-Specialty Group Taxonomy (193200000X)
- Multi-State DEA Registration
- National Practitioner Data Bank (NPDB)
- National Provider Identifier (NPI)
- National Uniform Claim Committee (NUCC)
- NCCI
- NCCI Edit Rules
- NCQA-Certified CVO
- NDC Unit
- Necessary Service
- Net Collection Rate
- Net Collections
- Net Profit Margin
- Network Participation
- Non-Facility RVU
- Non-Network Participating Provider
- Non-Participating Provider
- Non-Physician Provider (NPP)
- No-Show Rate
- NPI Mismatch
- NPI Type 1
- NPI Type 2
- Nurse Practitioner (NP)
- Online Reputation for Doctors
- Operational Drift
- Opioid Prescribing Education
- Opioid Use Disorder
- Organizational Relationship
- Originating Site
- Out-of-Network Benefits
- Overpayment Recovery
- Package Code (NDC)
- Package Handling (Virtual Address Services)
- Panel Management
- Panel Participation
- PA Number
- Participation Status
- Patient Engagement Strategy
- Patient Engagement Tools
- Patient Loyalty
- Patient Portal
- Patient Recall System
- Patient Recall Workflow
- Patient Retention
- Patient Satisfaction Surveys
- Patient Segmentation
- Patient Volume Surge
- Payer Contract
- Payer Denial
- Payer Guidelines
- Payer ID
- Payer Network
- Payer Portal
- Payer Portal Management
- Payment Posting
- Payor-Specific Rules
- PCSS
- PECOS
- Per Diem Payment
- Permission Mismatch
- PHI
- Physician Assistant (PA)
- Place of Service (POS) Codes
- Plan-Specific Guidelines
- Point-of-Care Testing
- Portal Adoption
- Portal Metrics
- Post-Payment Audit
- Practice Management System (PMS)
- Preventive Care Revenue
- Pricing Table
- Primary Diagnosis
- Primary Source Verification (PSV)
- Primary Verification Phase
- Prior Authorization
- Proactive Outreach
- Procedure Modifier
- Product Code (NDC)
- Professional Liability Insurance
- Provider Affiliation
- Provider Contracting
- Provider Credentialing
- Provider Enrollment
- Provider Onboarding
- Provider Relations
- Provider Relocation
- PTAN (Provider Transaction Access Number)
- QR Code Surveys
- Quality Control Logs
- QW Modifier
- Reactive Management
- Real‑Time Eligibility Check
- Real-Time Eligibility Check
- Real-Time Eligibility (RTE)
- Real-Time Eligibility Verification
- Real-Time Monitoring
- Reassignment
- Reciprocal Billing
- Reciprocal Billing Arrangement
- Re-Credentialing
- Referral Coordinator
- Referral End Date
- Referral Expiration
- Referral Expiration
- Referral Limit
- Referral Log
- Referral Management
- Referral Specialist
- Referral Specialist
- Referral Tracking
- Referral Validity
- Reimbursement
- Rejected Claim
- Relative Value Unit (RVU)
- Rendering Provider
- Rental Caps / Capped Rental
- Retroactive Authorization
- Retroactive Recoupment
- Retro Auth
- Retro Authorization
- Revalidation
- Revenue Cycle Management (RCM)
- Revenue Leakage
- Risk Adjustment
- Risk Adjustment Coding
- Role-Based Access
- Role-Based Access Control (RBAC)
- Ryan Haight Act
- SaaS Agreement
- SAMHSA
- Schedule III Controlled Substance
- Scope of Practice
- Secondary Diagnosis
- Secure Messaging
- Self-Pay
- Service Expansion
- Service Location
- Service Location Address
- Shared Savings Program
- Site Visit
- Skilled Nursing Facility (SNF)
- Staff Competency Documentation
- Staff Onboarding
- Standard Operating Procedures (SOP)
- State Licensure
- State Medical Board CME
- Substance Use Disorder
- Substance Use Disorder Training
- Substitute Physician
- Superbill
- Supervising Physician
- Surgical Privileges
- Surrogate
- Surrogate Relationship
- System Integration
- System Outage
- Tax Identification Number (TIN)
- Taxonomy Code
- Teaching Physician Supervision
- Telehealth
- Telehealth Licensing Requirements
- Telehealth Organization
- Telemedicine Prescribing
- Temporary Privileges
- Text Surveys for Patients
- The National Plan and Provider Enumeration System (NPPES)
- Third-Party Vendor
- Time Frame (Authorization)
- TPE (Targeted Probe and Educate)
- TRICARE
- TRICARE Allowable Rate
- TRICARE East
- Tricare for Life (TFL)
- TRICARE West
- TriWest
- Two-Factor Authentication (2FA)
- Unspecified Code
- Upcoding / Templates (Audit Trigger)
- USPS Form 1583
- VA Community Care
- Validity Period
- Value-Based Care
- VA Referral Authorization
- Vendor Audit
- Vendor Contract
- Vendor Governance
- Vendor Guarantee
- Vendor Operational Risk
- Vendor Red Flag
- VFC (Vaccines for Children)
- Virtual Business Address
- Visit Cap
- Visit Limit
- W-9 Form
- Word-of-Mouth Marketing in Healthcare
- X DEA Designation
- Z Codes