The definition of Revenue Cycle Management (RCM) in healthcare is the process of managing your office’s claims processing, payment and revenue generation. The entire healthcare revenue cycle process includes everything from determining patient eligibility, collecting their co-pay, coding claims correctly, tracking claims, collecting payments and following up on denied claims.
For successful health care revenue cycle management the staff should understand the coding errors, data quality errors in patient demographics, insurance and claim processing information. A simple failure in daily job or in work flow can affect the revenue.
Typically the office will be busy and if all the staff should understand their role in the office. The communication between the staff should be open and regular review meetings can identify the problems and rectify it.
If the system is wrong everything will be wrong. A proper and established workflow can end up with missing steps and forgetting tasks. It can end up from increased errors and delays to getting paid.
In order to efficiently manage the patient revenue cycle of your office, you’ll need medical billing software or practice management software that allows you to effectively keep track of the claims process.
CHISS offers an internationally designed training program for Revenue Cycle Management and it covers all the aspects of health care revenue cycle management for Indian health care environment and for other parts of the world.
CHISS curriculum of RCM is designed for 4 months and after completing the training program the students can appear for the international RCM examination, CRCR (Certified Revenue Cycle Representative) by HFMA (Health Care Financial Management Association). But the certification is not limited to obtain jobs in RCM. The curriculum includes
Types of encounters
Types of patient visit
Patient Access KPI
Work flow process
Introduction to Insurance
Overview of US/UAE/Qatar/Saudi Insurance market
Schedule of benefits
Introduction to medical documentation
Charge capture mechanism
Introduction to Medical Coding
Different types of Codes
Principle and Secondary Diagnosis
Sequencing of Diagnosis
Post discharge processing
Incomplete records – Communicating with Physicians
Creating Clean Claims
Monitoring coding quality
Impact of internal guidelines
Submission of claims
Sources of financial data
Major categories of Financial Account
HIM role in Cost Accounting
Follow up for payment
Use of Edits
Reimbursement and Contract Management
Audits and Denials
Introduction to Denials
Different types of Denials
Scenario based analysis
Introduction to Revenue cycle KPI