CHISS Offers a unique program

Revenue cycle management

Revenue cycle management has become one of the most popular functions for healthcare providers to outsource, mainly due to its critical importance in managing providers’ internal functionalities in an efficient and cost-effective manner.

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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