Revenue-cycle language should make the problem clearer, not harder to understand.

Money that remains outstanding after healthcare services have been provided and billed.

A/R can include claims waiting for payment, denied claims, unresolved balances, patient balances and other amounts that have not yet reached final financial resolution.

Also search: A/R, AR, Accounts Receivable

The grouping of outstanding accounts according to how long they have remained unresolved.

Common ageing ranges include:

0–30 days, 31–60 days, 61–90 days, 91–120 days and more than 120 days.

Age alone does not explain why an account remains open.

Also search: AR ageing, A/R aging, AR aging

A change applied to the amount owed on a claim or account.

An adjustment can be contractual, administrative, approved, disputed or potentially incorrect depending on the circumstances.

An adjustment should not automatically be treated as lost revenue.

A result or pattern that differs meaningfully from what is normally expected.

An anomaly may justify investigation but does not automatically mean that something is wrong.

A formal request asking a payer to reconsider a denial, payment decision or other claim outcome.

The designation of a person, team or role responsible for an item of work.

In CRIS, assignment helps make ownership visible.

A chronological record of important actions performed within a system.

It may show who performed an action, what changed and when it happened.

Also search: audit log

The amount that remains unresolved on a claim, account or financial transaction after payments, adjustments and other activity have been applied.

A stage in a process where work accumulates, slows down or repeatedly becomes stuck.

A defined instruction used to determine how information should be classified, calculated, routed or controlled.

Examples include ageing thresholds, escalation rules and underpayment logic.

Also search: rule

A request for payment submitted to a payer for healthcare services provided.

A claim normally contains information about the patient, provider, service, charges and other information required for adjudication.

The current state of a claim within its processing journey.

Examples may include submitted, accepted, rejected, pending, denied, paid or otherwise resolved.

A status does not always describe the complete financial outcome.

The controlled completion of an issue, account, task or investigation after the required action and evidence have been completed.

Closing something should mean more than simply marking it complete.

Revenue actually received from payers, patients or other responsible parties.

Also search: collections

An authorised process through which a user with appropriate permission can view protected patient identity information when a legitimate operational reason exists.

The action should remain controlled and auditable.

A measure designed to prevent, detect, identify or respond to an unwanted condition.

Controls can be preventive, detective or corrective.

An action taken to address the underlying cause of a problem so that it is less likely to happen again.

Correcting one affected claim is not necessarily the same as correcting the underlying cause.

The process of connecting fields in a source file or system to the corresponding fields expected by CRIS.

Also search: mapping

Checks performed to determine whether incoming information satisfies required rules for structure, format, completeness or permitted values.

Also search: validation

A payer decision not to pay all or part of a claim as submitted.

A denial can occur for many reasons and may sometimes be correctable or appealable.

The proportion of claims, claim lines or value experiencing denial within a defined population and period.

The calculation method should always be understood before comparing denial rates.

The reason given for a payer's denial decision.

CRIS may group related denial reasons to help identify recurring patterns.

A record that appears to represent information already received or processed.

Duplicate protection helps prevent the same information from being counted more than once.

The date by which an action should be completed.

The controlled movement of an issue to a higher level of attention because defined conditions have been met.

These may include overdue work, financial value, repeated failure or unresolved risk.

Information that supports a conclusion, decision, action or reported result.

Evidence may include source records, remittances, contracts, notes, approvals or system history depending on the issue.

A situation that falls outside an expected rule, threshold or normal process.

An exception does not necessarily indicate an error.

The amount an organisation expects to receive for a service based on the relevant reimbursement basis.

That basis may come from a contract, fee schedule, approved rule or another governed source.

A healthcare location, business unit or operating site represented within CRIS.

Facility-level reporting allows performance to be viewed without losing the organisation-wide picture.

The process of comparing financial records or totals to determine whether they agree and investigating differences.

Action taken to progress an unresolved claim, balance, denial, appeal or other revenue-cycle item.

Good follow-up should move the item toward resolution rather than simply create another activity record.

A source of information that has been approved for a defined use and is subject to appropriate controls.

The record of information imported into CRIS, including when it was received and what happened during processing.

The structured review of a condition requiring explanation before a conclusion is reached.

For example, a payment variance may require investigation before it can be called an underpayment.

A defined measure used to monitor an important aspect of performance.

A KPI should help management understand performance or decide where attention is needed.

Also search: KPI, Key Performance Indicator

See Source lineage.

Lineage describes how information can be traced from the result back through the calculations, rules and records that produced it.

A result or condition that deserves management attention.

A signal is intended to prompt investigation or action rather than merely display another metric.

A presentation of patient information in which identifying details are hidden or reduced where they are not required.

An amount that has not yet been fully resolved through payment, adjustment or another appropriate financial action.

The person, team or role accountable for progressing an item.

Ownership should make it clear who is responsible for the next action.

A controlled CRIS identifier used to connect records relating to the same patient while limiting unnecessary exposure of direct patient identifiers.

The Patient Key supports analysis and record linking without making patient identity the primary identifier displayed across CRIS.

It is part of CRIS's approach to separating analytical identity from direct patient identity.

Also search: patient identifier, internal patient key

An organisation responsible for paying some or all of the cost associated with healthcare services.

Depending on the healthcare environment, this may include an insurance company, health plan, government programme or another responsible payment entity.

A view of how a payer behaves across relevant revenue-cycle measures.

This may include payment speed, denials, unresolved balances, underpayment patterns and follow-up burden.

Money received against a claim, account or service.

A payment does not automatically mean the account is fully resolved.

The difference between two relevant payment-related amounts.

For example, expected reimbursement and actual payment.

A payment difference requires context before it can be classified.

A measurable difference between an expected financial amount and an observed amount.

A variance is an analytical finding, not automatically an underpayment.

A payment variance or other condition that suggests the payer may have paid less than expected but has not yet been sufficiently investigated to confirm that conclusion.

The relative importance or urgency assigned to work.

Priority may consider value, age, deadline, risk, recurrence and other defined factors.

A controlled comparison used to determine whether records, totals or sources agree.

Where differences exist, reconciliation should identify and explain them rather than simply reporting that two numbers are different.

Revenue successfully obtained after action is taken on an identified financial issue.

Finding a potential financial opportunity is not the same as recovering it.

An amount that may potentially be recoverable but has not yet reached a verified recovery outcome.

A claim that fails an initial processing or acceptance requirement and therefore does not progress normally into payer adjudication.

A rejection is not necessarily the same as a denial.

Information received from a payer explaining how submitted claims were processed financially.

It may include payments, adjustments, denial information and other adjudication details.

Also search: ERA, EOB

The activities involved in turning healthcare services into appropriate financial outcomes.

RCM can include registration, charging, claim submission, payment, denial management, A/R, follow-up and final resolution.

Also search: RCM, Revenue Cycle Management

A financial amount associated with a condition that may require investigation or action.

Revenue exposure should not automatically be reported as revenue loss or recoverable cash.

For example:

A payment variance may represent exposure.

Further investigation may determine that it is valid.

Another investigation may establish a validated underpayment.

Only subsequent activity may result in a verified recovery.

The discipline of helping ensure that healthcare services are captured, billed, paid, adjusted and reported appropriately.

Revenue that fails to reach the appropriate financial outcome because of an issue in the revenue cycle.

Potential leakage should be distinguished from confirmed financial loss.

A defined expectation for how quickly or under what conditions work should be completed.

Within operational workflows, an SLA may trigger reminders or escalation when work becomes overdue.

Also search: SLA, service level

The information received from the original system, file or process that CRIS uses for analysis or operations.

A file supplied to CRIS as an input source.

Common formats may include CSV or XLSX where those formats are supported.

Also search: CSV, XLSX

The traceable relationship between a CRIS result and the information used to produce it.

Lineage can help answer:

Where did this result come from?

Which source record contributed to it?

Which rule or calculation was applied?

Was the source changed?

Can the result be recreated?

Also search: lineage, data lineage

The review of incoming data to understand its structure, completeness, values and potential quality issues before it is used.

The system from which information originates before entering CRIS.

A logically separated customer or organisation environment within a multi-tenant platform.

Tenant separation is intended to prevent one customer's information from being available to another customer without authorised design.

Also search: tenant isolation

A defined value at which a condition changes classification or triggers an action.

For example, an ageing threshold may determine when an account requires escalation.

A pattern of movement observed across time.

A trend usually requires multiple observations rather than a single result.

A condition in which the amount paid is lower than the amount appropriately expected under the relevant reimbursement basis.

CRIS distinguishes different stages of certainty around underpayments.

This distinction matters because not every payment difference is money owed by the payer.

An underpayment conclusion that has been supported by sufficient relevant evidence.

Validation should consider the expected reimbursement basis, actual payment, adjustments and other relevant claim or contractual information.

The process of checking whether information, a calculation or a conclusion satisfies defined requirements.

A difference between two amounts, results or conditions.

A variance identifies a difference. It does not by itself explain why the difference exists.

A completed outcome supported by sufficient evidence.

CRIS uses the concept to distinguish a final supported result from an assumption, preliminary finding or unresolved opportunity.

A recovery outcome supported by evidence showing that the relevant revenue was actually received or otherwise appropriately resolved.

A defined piece of operational work requiring attention.

A work item may include ownership, priority, due date, status, evidence and closure requirements.

A controlled list of work requiring attention.

A useful queue helps users understand what needs to be worked, why it matters and what should happen next.

The controlled sequence through which work moves from initiation to completion.

A workflow may include assignments, decisions, approvals, due dates, notifications, escalations and closure.