What is the difference between CPT, HCPCS, and ICD-10?

CPT (Current Procedural Terminology) is the AMA-maintained code set for procedures and services. HCPCS Level II covers supplies, DME, drugs, and other items not in CPT — maintained by CMS. ICD-10-CM codes describe diagnoses (what the patient has); ICD-10-PCS codes describe inpatient procedures. A clean claim typically carries ICD-10-CM diagnosis codes plus CPT or HCPCS procedure codes linked via modifiers.

What is a good clean claim rate benchmark?

HFMA MAP Keys place the top-quartile clean claim rate benchmark at 95% or higher. The industry median is around 85–90%. Clean claim rate measures the percentage of claims accepted by the payer on first submission without edits or rework. Organizations with mature AI coding and scrubbing routinely exceed 97%.

Which CARC codes are the most common denials?

CARC 197 (precertification / authorization absent), CARC 11 (diagnosis inconsistent with procedure), and CARC 16 (claim lacks information) are the three highest-volume CARCs across 2026 industry data. Together they account for over half of all denied claim dollars. CARC 45, CARC 29, and CARC 96 round out the top six.

Who reviews the QuickIntell glossary entries?

Each glossary entry is reviewed by QuickIntell's RCM editorial team. Credentialed reviewers (CRCR, CPC, CCS with 5+ years of revenue cycle experience) stamp each record's last_reviewed date. Staleness SLA is 365 days — every entry is re-reviewed at least annually to track payer policy, code set updates, and benchmark shifts.

Healthcare RCM & Medical Billing Glossary

Plain-English definitions for 405 revenue cycle, medical-billing, coding, denial, payer, and compliance terms. Every entry leads with a 40–60 word answer block, followed by a formula (where one exists), an industry benchmark, and a worked example — reviewer-authored, cited inline.

Reviewed by QuickIntell Editorial Team · Last reviewed April 23, 2026

Updated Apr 23, 2026

All terms RCM Coding Denials Payer Clinical Docs Compliance

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21st Century Cures ActCompliance
aka Cures Act, Cures, 21st Century Cures
The 21st Century Cures Act is a 2016 federal law that, among other provisions, established the information-blocking prohibition and mandate…

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