A
- Accounts receivable (A/R) days
- The average number of days it takes a practice to collect payment after a service is billed. Rising A/R days are an early warning of billing or denial problems. Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
- Ambulatory surgery center (ASC)
- A licensed facility for procedures that don't need a hospital stay — patients go home the same day. Many are owned wholly or partly by physicians, and they are paid under their own Medicare payment system, usually at lower rates than hospital outpatient departments. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
- Anti-Kickback Statute (AKS)
- A federal criminal law that prohibits knowingly and willfully offering, paying, soliciting or receiving anything of value to induce or reward referrals of items or services paid by federal healthcare programs. Intent matters, and safe harbors protect arrangements that meet every condition. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
C
- Capitation
- A payment model in which a provider receives a fixed amount per patient per month to cover an agreed set of services, regardless of how much care each patient uses. It shifts financial risk from the insurer to the provider.
- Claims-made vs. occurrence malpractice insurance
- An occurrence policy covers incidents that happen while the policy is active, whenever the claim is filed. A claims-made policy covers claims filed while it is active, so a doctor who changes jobs often needs "tail" coverage for claims that arrive later. Read more: Reading Your First Physician Employment Contract
- Clean claim
- A claim that is complete and accurate when first submitted and can be paid without additional information. A high clean-claim rate means fewer denials and faster payment. Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
- Concierge medicine
- A practice model in which patients pay a membership or retainer fee for more access to their physician — longer visits, same-day appointments, direct contact. Some concierge practices also bill insurance for covered services; others don't.
- Conversion factor
- The dollar amount Medicare multiplies by a service's geographically adjusted relative value units to set its payment under the Physician Fee Schedule. CMS updates it every year. Read more: RVU-Based Compensation Explained
- CPT code
- Current Procedural Terminology: the five-character codes, maintained by the American Medical Association, that describe what a clinician did — a visit, a test, a procedure. Most professional billing in the U.S. is built on them. Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
- Credentialing
- The process of verifying a clinician's training, licenses and history before a hospital grants privileges or an insurer adds them to its network. Many commercial insurers draw this information from a shared database run by CAQH, which now operates as DataSpring. Read more: Starting or Buying a Private Practice
D
- Denial (claim denial)
- An insurer's refusal to pay all or part of a claim — for missing information, coding errors, lack of prior authorization or medical-necessity disputes. Managing denials is a large part of a practice's revenue cycle. Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
- Designated health services (DHS)
- The categories of services covered by the Stark Law, including clinical laboratory, imaging, physical therapy, durable medical equipment and inpatient and outpatient hospital services. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
- Doctor Lease Back program
- A program founded by Dr. Irfan Siddiqui that helped physicians strengthen their practices and finances through the lease-back idea: owning practice real estate separately and leasing it to the practice. Read more: Owning Your Building: Sale-Leaseback and the Doctor Lease Back Model
- The system Medicare and many insurers use to pay hospitals a set amount for an inpatient stay based on the patient's diagnosis, procedures and complications, rather than itemizing every service. Accurate documentation determines which DRG applies. Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
E
- Employed vs. independent physician
- An employed physician works for a hospital, health system or large group and is paid a salary, often with productivity bonuses. An independent physician owns or co-owns a practice and carries its business risk — and its rewards. Read more: Starting or Buying a Private Practice
F
- Facility fee
- A charge billed by a hospital, hospital-owned clinic or ASC for use of its space, equipment and staff, separate from the physician's professional fee. The same visit can cost more in a hospital-owned setting because of it. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
- Fair market value (FMV)
- The price that would be agreed between well-informed parties dealing at arm's length, without regard to referrals. Leases and compensation between parties who can refer to each other generally must be at fair market value. Read more: Owning Your Building: Sale-Leaseback and the Doctor Lease Back Model
- Fee schedule
- A list of what a payer will pay for each service. Medicare publishes its Physician Fee Schedule every year; commercial insurers negotiate their own schedules with practices and hospitals. Read more: Starting or Buying a Private Practice
I
- ICD-10 code
- International Classification of Diseases codes, used to record diagnoses. A claim pairs ICD-10 codes (why the patient was seen) with CPT or procedure codes (what was done). Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
- In-network vs. out-of-network
- An in-network provider has a contract with an insurer at agreed rates; an out-of-network provider doesn't. Patients usually pay more out of network, and federal rules now limit some surprise bills. Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
L
- Locum tenens
- Temporary physician work covering for another doctor or filling a staffing gap, usually arranged through an agency. Many physicians use it early in their careers or alongside other work. Read more: Physician Debt, Credit and the First Five Years of Finances
M
- Medicaid
- A joint federal and state program that covers health care for people with low incomes. Each state runs its own program within federal rules, so eligibility and payment rates vary widely.
- Medicare
- The federal health insurance program for people 65 and older and some younger people with disabilities. Part A covers hospital care, Part B physician and outpatient care, and Part D prescription drugs.
- Medicare Advantage
- Private health plans approved by Medicare that provide Part A and B benefits (and often drug coverage) in place of traditional Medicare. They are paid by Medicare and often use networks and prior authorization.
N
- Non-compete clause
- A contract term limiting where and for how long a physician may practice after leaving an employer. Enforceability depends on state law, and it is one of the most important terms to understand before signing a first contract. Read more: Reading Your First Physician Employment Contract
- NPI (National Provider Identifier)
- A unique 10-digit number every U.S. healthcare provider uses on claims. Individuals (Type 1) and organizations (Type 2) each have their own, issued through the national NPPES registry. Read more: Starting or Buying a Private Practice
O
- Office-based lab (OBL)
- A procedure suite run inside a physician's practice — common in vascular and interventional care — where certain catheter-based procedures can be performed outside a hospital. Medicare pays it under the Physician Fee Schedule rather than with a separate facility fee. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
P
- Payer mix
- The share of a practice's patients or revenue that comes from each type of payer — Medicare, Medicaid, commercial insurers and self-pay. It strongly affects what a practice collects for the same work. Read more: Starting or Buying a Private Practice
- An insurer's requirement to approve a test, procedure or drug before it is provided in order for it to be covered. It is a major administrative burden for practices and a frequent cause of delays. Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
- Private Insurance Operating Cardiac Model
- A model founded by Dr. Irfan Siddiqui in which a physician works directly with private insurers so that appropriate cardiac procedures can be performed in an outpatient, office-based setting at lower total cost than the hospital. It is used nationally. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
- Professional fee
- The charge for a clinician's own work — the exam, the reading of a test, the procedure itself — billed separately from any facility fee. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
- Public Service Loan Forgiveness (PSLF)
- A federal program that can forgive the remaining balance on eligible federal Direct Loans after 120 qualifying payments made while working full-time for a qualifying government or nonprofit employer. Read more: Physician Debt, Credit and the First Five Years of Finances
R
- Revenue cycle management
- Everything between a patient's appointment and the practice being paid: registration, insurance checks, coding, claim submission, follow-up on denials and patient billing. Many practices outsource part of it. Read more: Medical Billing, Coding and Denials: What Every Physician Should Understand
- RVU (relative value unit)
- A measure Medicare uses to rank services by the work, practice expense and malpractice cost involved. Work RVUs (wRVUs) are also widely used to set employed physicians' productivity pay. Read more: RVU-Based Compensation Explained
S
- Safe harbor
- A set of conditions published by the HHS Office of Inspector General. An arrangement that meets every condition of a safe harbor is protected from prosecution under the Anti-Kickback Statute. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
- Sale-leaseback / owning your building
- Arrangements in which a physician (often through a separate company) owns the property a practice uses and leases it back to the practice — or sells a building it owns to an investor and leases it back. Leases between related parties must be at fair market value and structured with legal and tax advice. Read more: Owning Your Building: Sale-Leaseback and the Doctor Lease Back Model
- Stark Law (physician self-referral law)
- A federal law that prohibits a physician from referring Medicare patients for designated health services to an entity with which the physician or an immediate family member has a financial relationship, unless an exception applies. It is strict liability: intent does not matter. Read more: Outpatient Labs, Office-Based Labs and Ambulatory Surgery Centers
T
- Tail coverage
- Extended reporting coverage purchased when a claims-made malpractice policy ends, covering claims filed later about care provided while the policy was active. Contracts should say who pays for it. Read more: Reading Your First Physician Employment Contract
- Telehealth
- Care delivered remotely by video, phone or messaging. Its use and coverage expanded sharply during the COVID-19 pandemic, and payment rules continue to evolve.
- A concept founded by Dr. Irfan Siddiqui that applies the timeshare idea to clinical space: other physicians use a cardiac procedure suite for scheduled blocks of time, so expensive facilities are used efficiently. It is used nationally. Read more: Shared Procedure Suites: The Time Share Cardiac Suite Concept
- A narrow Stark Law exception, added in 2016, for part-time use of premises and equipment used predominantly for evaluation and management services. It excludes advanced imaging, radiation therapy and most lab equipment, and bars percentage-based or per-unit fees. Read more: Shared Procedure Suites: The Time Share Cardiac Suite Concept
V
- Value-based care
- Payment approaches that reward quality and outcomes rather than the number of services — for example, shared-savings programs and accountable care organizations (ACOs).
W
- Work RVU (wRVU)
- The physician-work component of a service's relative value. Employers commonly multiply a physician's wRVUs by a contracted dollar rate to calculate productivity pay. Read more: RVU-Based Compensation Explained
Educational information only — not legal, financial, tax or billing advice. Consult qualified advisors.