10-530-157 Revenue Cycle Management
Course Information
Description
Develops skills in managing the revenue cycle by collaborating with teams, ensuring compliance, and applying measures to improve efficiency. Learners will evaluate coding practices for fraud and abuse, conduct audits, and handle appeals. Additionally, learners will analyze utilization data, manage the charge description master (CDM), and conduct clinical documentation improvement (CDI) activities to enhance documentation and reimbursement accuracy.
Total Credits
2
Course Competencies
  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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