The RCM Wiki
The free encyclopedia of medical billing, coding, credentialing and revenue cycle management — 328 entries, written by working billers, updated against current CMS and payer policy.
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Every revenue-cycle term, explained in plain English.
What each denial code means, the fix, and the appeal path.
Remittance remark codes decoded.
When each modifier applies — and when it triggers a denial.
Individual code guides with 2026 Medicare rates.
Every POS code and how it changes payment.
CAQH, PECOS, NPI, payer enrollment — the whole pipeline.
Appeals, filing limits, and quirks — payer by payer.
HIPAA, No Surprises Act, Stark, MIPS and state law.
CMS rules, fee schedules, and program billing.
Front desk to A/R — running the business side.
835s, 837s, clearinghouses and electronic workflows.
CPC, CPB, salaries and what billers and coders do.
Most-read entries
CO-45 means the charge exceeds the fee schedule, maximum allowable, or contracted/legislated fee arrangement. It is a contractual…
RCM Glossary Clean ClaimA clean claim is a medical claim that passes payer edits and is paid on first submission — no errors, no missing data, no manual …
CPT Modifiers Modifier 25: A Significant, Separate E/M Visit on the Same Day as a ProcedureModifier 25 tells the payer an E/M visit on the same day as a minor procedure was significant and separately identifiable, so bot…
RCM Glossary Accounts Receivable Days (A/R Days)A/R days measures how long, on average, it takes a practice to collect payment after a service is billed. Formula: total accounts…
Denial Codes (CARC) CO-97 Denial Code: Benefit Included in Payment for Another ServiceCO-97 means the benefit for this service is included in the payment or allowance for another service already adjudicated — a bund…
Credentialing & Enrollment CAQH ProView (DataSpring)CAQH ProView is the universal online credentialing profile most commercial payers pull provider data from; in 2026 CAQH rebranded…
RCM Glossary ERA vs EOB: The DifferenceAn ERA and an EOB describe the same claim adjudication in two formats for two audiences: the ERA is the machine-readable X12 835 …
RCM Glossary Timely Filing LimitA timely filing limit is the payer's deadline for submitting a claim, counted from the date of service. Medicare allows 12 months…
CPT & HCPCS Codes HCPCS G2211: Visit Complexity Add-On for Longitudinal E/M CareHCPCS G2211 is an add-on for the inherent visit complexity of an office/outpatient E/M when the provider is the continuing focal …
RCM Glossary Prior AuthorizationPrior authorization is payer approval obtained before a service is performed, required for many imaging studies, surgeries, speci…
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Recently updated
- CPT 10060: Incision and Drainage of Abscess, Simple
- CPT 11042: Debridement, Subcutaneous Tissue, First 20 sq cm
- CPT 11721: Debridement of Nails, 6 or More
- CPT 12001: Simple Repair, Scalp/Neck/Axilla/Trunk 2.5 cm or Less
- CPT 17000: Destruction of Premalignant Lesion, First Lesion
- CPT 20552: Trigger Point Injection, 1 or 2 Muscles
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