10-530-159Healthcare Revenue Management
Course Information
Description
Prepares learners to compare and contrast healthcare payers and evaluate the reimbursement cycle and compliance with regulations. Learners assign payment classifications with entry level proficiency using computerized encoding and grouping software.
Total Credits
3
Course Competencies
  1. INVESTIGATE trends that have an impact on the healthcare cost and reimbursement systems
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    you evaluate sociological and governmental trends that affect healthcare cost and reimbursement
    you evaluate the trends in prospective payment and other cost-containing reimbursement methodologies
    you evaluate the role of value based purchasing and other quality of care initiatives that impact healthcare reimbursement

  2. COMPARE government and non-government payers and payment methodologies
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    you compare eligibility
    you compare benefits
    you compare cost and utilization controls
    you compare payment methodologies
    you compare administration and oversight

  3. MANAGE the revenue cycle
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    you identify the roles of stakeholders in the revenue cycle
    you collaborate on interdisciplinary revenue cycle activities
    you apply measures to the revenue cycle to ensure efficiency (case mix, DNFB, etc.)
    you manage compliance with regulatory guidance and standards

  4. ENSURE compliance with regulations related to fraud and abuse
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    you investigate governmental initiatives for identification and resolution of fraud and abuse
    you evaluate coding and billing practices for fraud and abuse
    you provide recommendations to resolve issues associated with fraud and abuse

  5. APPLY various prospective payment systems (e.g., MS-DRG, APC, RBRVS)
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    your diagnostic/procedural grouping is supported by medical documentation
    your diagnostic /procedural grouping ensures optimal reimbursement
    your diagnostic /procedural grouping selection process is articulated

  6. CONDUCT activities related to revenue cycle audits
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    you interpret the audit report results
    you justify your findings
    you determine if an appeal is necessary
    you respond to an appeal

  7. MANAGE the claim processes within the revenue cycle
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    you prepare a claim for reimbursement
    you assess a claim for accuracy
    you resolve claim edits
    you manage claim denials

  8. MANAGE the charge description master (CDM)
    Assessment Strategies
    Oral, written or graphic assessment
    Criteria
    you recognize the components of the charge master
    you evaluate the charge description master (CDM) for accuracy
    you comply with coding and billing regulations