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MANAGE the revenue cycle
Assessment Strategies
Oral, written or graphic assessment
Criteria
identify the roles of stakeholders in the revenue cycle
collaborate on interdisciplinary revenue cycle activities
apply measures to the revenue cycle to ensure efficiency (case mix, DNFB, etc.)
manage compliance with regulatory guidance and standards
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ENSURE compliance with regulations related to fraud and abuse
Assessment Strategies
Oral, written or graphic assessment
Criteria
investigate governmental initiatives for identification and resolution of fraud and abuse
evaluate coding and billing practices for fraud and abuse
provide recommendations to resolve issues associated with fraud and abuse
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CONDUCT activities related to revenue cycle audits
Assessment Strategies
Oral, written or graphic assessment
Criteria
interpret the audit report results
justify your findings
determine if an appeal is necessary
respond to an appeal
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EVALUATE utilization data for patterns, trends and opportunities for improvement
Assessment Strategies
Oral, written or graphic assessment
Criteria
explain the historical development and goals of utilization management
outline the utilization management structure and process
differentiate between the various types of utilization management reviews
investigate tools and techniques that contribute to the efficient use of resources in the provision of patient care
draw conclusions based on utilization data
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MANAGE the charge description master (CDM)
Assessment Strategies
Oral, written or graphic assessment
Criteria
recognize the components of the charge master
evaluate the charge description master (CDM) for accuracy
comply with coding and billing regulations
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CONDUCT Clinical Documentation Improvement (CDI) activities
Assessment Strategies
Oral, written or graphic assessment
Criteria
communicate with providers and others to obtain documentation that clearly and accurately reflects the acuity and severity of the patient’s illness
verify that documentation and associated medical codes support the level of care and medical necessity of services provided
educate providers and other clinicians on documentation best practices
monitor the query process for compliance concerns
analyze clinical documentation integrity metrics for efficacy
recommend improvements for processes that affect the quality of documentation and the resulting accuracy of reimbursement