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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
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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
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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
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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
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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
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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
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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
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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