Role of the revenue cycle process


Assignment:

Introduction

As a future CCA, CCS or RHIT professional you must be able to provide education to providers and other professionals. This type of presentation may occur in the form of a face to face presentation or a presentation that is recorded and deployed to others.

Instructions

For this course, you will assume the role of the Revenue Cycle expert who is charged with preparing and presenting a 60 minute session on the Revenue Cycle to new employees. Your goal is to ensure that these new employees understand the revenue cycle process and the role that they may play within your organization.

Presentation Outline/Contents

Your presentation is a 60 minute session and must be presented in the following order:

  • Title Slide
  • Introduction (Presenter)
  • Graphical Representation of the Revenue Cycle
  • Insurance Terminology (10 terms)
  • Patient Access/Registration Process
  • Insurance Verification Process
  • Coordination of Benefits
  • Pre-approval Process
  • Payers-Managed Care (HMO, PPO, POS, EPO)
  • Payers-Government (Medicare, Medicaid, Tricare)
  • Prospective Payment Systems (Focus on MS-DRG, APC and RBRVS)
  • Coding Process
  • Chargemaster
  • Coding Compliance
  • Claims Edits (NCCI, MCE, OCE)
  • Claims Submission Process (CMS-1500 vs UB-04)
  • Notification of Payment (EOB vs RA/ERA)
  • Denial Management
  • Discharged Not Final Billed Reports
  • Medicare Appeals Process
  • Conclusion
  • References

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