Revenue cycle management

The definition of Revenue Cycle Management (RCM) in healthcare is the process of managing your office’s claims processing, payment and revenue generation. The entire healthcare revenue cycle process includes everything from determining patient eligibility, collecting their co-pay, coding claims correctly, tracking claims, collecting payments and following up on denied claims.

Current scenarios in Health Care Revenue Cycle

UNQUALIFIED STAFF

For successful health care revenue cycle management the staff should understand the coding errors, data quality errors in patient demographics, insurance and claim processing information. A simple failure in daily job or in work flow can affect the revenue.

LACK OF COMMUNICATION

Typically the office will be busy and if all the staff should understand their role in the office. The communication between the staff should be open and regular review meetings can identify the problems and rectify it.

STANDARDIZED WORKFLOW

If the system is wrong everything will be wrong. A proper and established workflow can end up with missing steps and forgetting tasks. It can end up from increased errors and delays to getting paid.

LACK OF EFFICIENT SOFTWARE

In order to efficiently manage the patient revenue cycle of your office, you’ll need medical billing software or practice management software that allows you to effectively keep track of the claims process.

CHISS curriculum of Revenue Cycle Management (RCM)

CHISS offers an internationally designed training program for Revenue Cycle Management and it covers all the aspects of health care revenue cycle management for Indian health care environment and for other parts of the world.

CHISS curriculum of RCM is designed for 4 months and after completing the training program the students can appear for the international RCM examination, CRCR (Certified Revenue Cycle Representative) by HFMA (Health Care Financial Management Association). But the certification is not limited to obtain jobs in RCM. The curriculum includes

1. Introduction to Revenue Cycle
2. Patient Access

Types of encounters
Types of patient visit
Scheduling Services
Eligibility check
Patient Registration
Cash Collection
Patient Access KPI
Work flow process
Important policies

3. Insurance Schemes

Introduction to Insurance
Overview of US/UAE/Qatar/Saudi Insurance market
Schedule of benefits
Authorization requirements

4. Documentation and Charge Captures

Introduction to medical documentation
Charge Types
Charge capture mechanism

5. Medical Coding

Introduction to Medical Coding
Different types of Codes
Principle and Secondary Diagnosis
Sequencing of Diagnosis

6. Record Completion and Coding

Post discharge processing
Incomplete records – Communicating with Physicians
Creating Clean Claims
Monitoring coding quality
Impact of internal guidelines

7. Medical Billing

Utilization review
Eligibility Check
Quality check
Claims review
Submission of claims
DNFB

8. Financial Basis

Sources of financial data
Major categories of Financial Account
HIM role in Cost Accounting

9. Accounts Receivable

Follow up for payment
Payment posting
Reconciliation

10. Claims Management

Clean Claims
Use of Edits
Reimbursement and Contract Management
Denial Management
Audits and Denials
Collection Management

11. Denial Analysis

Introduction to Denials
Different types of Denials
Scenario based analysis
Resubmission

12. Revenue Cycle Analytics

Introduction to Revenue cycle KPI

For more details regarding Certified Medical Coding Program ,Contact CHISS today.

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