Revenue Cycle Education Program

Library Summary

Introduction Course Bundle : Audience: Patient Access, Patient Accounts, HIM, Finance, Information Technology, Administrators, Board Member, Physicians, Physician Office Staff, Nursing/Clinicians, Managers, Ancillary Services, and Support Services.

• Introduction to the Revenue Cycle
• Introduction to Revenue Cycle Terminology
• Payer Identification
• Registration’s Link to the UB-04
• Bill Submission Tools
• Coding Basics
• Understanding Reimbursement
• Compliance... The Buzz
• Denial Management 101

Patient Access Course Bundle : Audience: Patient Access, Patient Accounts, HIM, Finance, Information Technology, Administrators, Board Member, Physicians, Physician Office Staff, Nursing/Clinicians, Managers, Ancillary Services, and Support Services.

• Who Are Our Customers?
• How Patients Access Care
• Intake… What is it All About?

Demographics Course Bundle : Audience: Patient Access, Patient Accounts, HIM, Finance, Information Technology, Physician Office Staff, Managers, and Ancillary Services.

• The Match Game
• The Key Players
• Getting to Know You
• All About the Key Players
• Demographics – Oops!

The Encounter Course Bundle : Audience: Patient Access, Patient Accounts, HIM, Finance, Information Technology, Physicians, Physician Office, Nursing/Clinicians, Managers, and Ancillary Services.

• Just What the Doctor Ordered
• Encounter Information of Another Kind
• The Encounter – Oops!

Health Insurance Course Bundle : Audience: Patient Access, Patient Accounts, HIM, Finance, Information Technology, Physicians, Physician Office, Nursing/Clinicians, Managers, and Ancillary Services.

• Let's Play Cards
• Medicare-World of Medicare
• Medicare-Front Office and Medicare
• Medicaid-Michigan
• TRICARE & CHAMPVA
• Health Insurance- Other Plans
• Health Insurance - Oops!

Verification Course Bundle : Audience: Patient Access, Patient Accounts, HIM, Finance, Information Technology, Physician Office Staff, Managers, and Ancillary Services.

• Verification Defined
• The Verification Flow
• Verification - Oops!

Coordination of Benefits Course Bundle : Audience: Patient Accounts, Patient Access, HIM*, Finance*, and Information Technology*, Information Technology*, Administrators*, Board Member*, Physicians*, Physician Office Staff*, Nursing/Clinicians*, Managers*, Ancillary Services*, and Support Services*.

• What is Coordination of Benefits?*
• Determining Coordination of Benefits*
• Medicare Secondary Payer Introduction*
• MSP Determination Process*
• MSP Documentation
• Workers' Compensation Assignment
• Auto Insurance Assignment
• Residential Accident Assignment
• Public Location Accident Assignment
• Entity Request Determination Process
• Multiple Plan COB Determination Process
• Coordination of Benefits - Oops!*

What Do I Owe? Course Bundle : Audience: Patient Access, Patient Accounts, HIM, Finance, Information Technology, Administrators, Board Member, Physicians, Physician Office Staff, Nursing/Clinicians, Managers, Ancillary Services, and Support Services.

• The Balancing Act
• Collection Touch
• Payment Solutions
• Communicating for Collection
• What Do I Owe? - Oops!

Anatomy of a UB Course Bundle : Audience: Patient Access, Patient Accounts, HIM, Finance, and Information Technology.

• The New World:  UB-04 Preparation
• Direct from the Horse's Mouth
• All About Me
• Once Upon a Time
• Show Me the Money
• One of a Kind
• All in the Family

Validating a Bill Course Bundle: Audience: Patient Accounts, Patient Access*, HIM*, Finance*, and Information Technology.

• Building a Bill*
• Validating a Basic Inpatient Bill
• Validating an Acute Inpatient Bill
• Validating a Combined Admit Inpatient Bill
• Validating a Mental Health Inpatient Bill
• Validating a Rehabilitation Inpatient Bill
• Validating Mom and Baby Inpatient Bills
• Validating a Basic Outpatient Bill
• Validating an Emergency Outpatient Bill
• Validating an Observation Outpatient Bill
• Validating a Surgery/Procedure Outpatient Bill
• Validating Other Outpatient Bills
• Validating a Therapy Outpatient Bill

Third Party Follow-Up Techniques Course Bundle: Audience: Audience: Patient Accounts, Patient Access*, HIM*, Finance*, and Information Technology.

• Life of a Bill*
• Follow-Up in a Nutshell – Part I*
• Follow-Up in a Nutshell – Part II*
• The Nuts & Bolts of Payments*
• Medicare Follow-Up
• Medicare Denials
• Medicare Remittance Advice
• Medicaid - Michigan Follow-up
• Blue Cross - General Follow-up
• Blue Cross - Michigan Follow-up
• Blue Cross Michigan - Web DENIS
• Blue Cross Michigan - COB
• Commercial and other Payer Follow-up

Introduction Learning Bundle

Introduction to the Revenue Cycle

.50 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces the revenue cycle of a Patient, departments and players in the revenue cycle, third party payers, the types of bills sent, revenue cycle tools, methods of payment, the importance of compliance, and what HIPAA means.

Course Learning Objectives:

• Define the revenue cycle.
• Identify some of the departments and players and their possible role in the revenue cycle.
• Name the hospital and professional/physician billing forms.
• Cite the importance of compliance in the revenue cycle.

Introduction to Revenue Cycle Terminology

.50 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces common healthcare terms, abbreviations, and acronyms associated with revenue cycle processes.

Course Learning Objectives:

• Recognize key revenue cycle terms and acronyms.

Payer Identification

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces how payers are identified and verified during the patient intake process.

Course Learning Objectives:

• Define verification.
• Recognize methods used to verify payer information.

Registration's Link to the UB-04

.75 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces the relationship of the data captured and entered into a Patient’s account, at the time of patient intake; to the production of a clean UB-04 claim form.

Course Learning Objectives:

• Identify the four sections of the UB-04.
• Recognize how information obtained during patient intake is used in the creation of a UB-04.
• Recognize the financial impact of incorrect payer assignment.

Bill Submission Tools

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces the computer systems utilized to generate paper and electronic bills.

Course Learning Objectives:

•   Recognize bill submission tool

Coding Basics                                                                                                          

.50 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces the two healthcare coding systems. ICD-9-CM codes used to describe the diagnosis and procedures associated with a Patient’s visit. HCPCS codes used to describe procedures, tests and supplies associated with a Patient’s visit.

Course Learning Objectives:

• Name the two healthcare clinical coding systems.
• Differentiate the two coding systems.
• Define Patient Financial Services role in code assignment.

Understanding Reimbursement

.50 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces the definition of reimbursement, methods of calculating reimbursement, and the reimbursement puzzle.

Course Learning Objectives:

• Define reimbursement.
• Define a third party payer contract.
• Recognize the characteristics of reimbursement.
• Differentiate between the terms charges, reimbursement, and contractual adjustment.
• Select, when given its definition, the reimbursement methodology for: total charges, discount on charges, cost based, per diem, fee for service, IPPS/DRG, OPPS, and capitation.

Compliance… The Buzz

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces the issues surrounding compliance, specifically Medicare's billing, reimbursement, and coding policies, as well as the Office of the Inspector General's (OIG) work plan.

Course Learning Objectives:

• Define the False Claims Act.
• Define the Office of the Inspector General and recognize its abbreviation.
• Define the Centers for Medicare and Medicaid Services and list its abbreviation.
• Name two federal entities that assist with fraud and abuse investigations (The Federal Bureau of Investigation and the Department of Justice).
• List four common types of billing errors.
• Specify your role as it relates to compliance.
• Recognize the impact of compliance errors.

Denial Management 101

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25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces the denial management process, including common types of denials, methods of monitoring and tracking denials, and the impact denials have on the financial success of the hospital.

Course Learning Objectives:

• Define denial management.
• List four common types of payment denials.
• Cite methods of tracking and monitoring payment denials.
• Recognize the financial impact of payment denials.

Patient Access Learning Bundle

Who are Our Customers?

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies healthcare customers and methods of interaction and communication.

Course Learning Objectives:

• Identify healthcare customers.
• Name four customer focused communication characteristics.
• Identify methods of communicating with healthcare customers.

How Patients Access Care

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies how Patients access care in the hospital.

Course Learning Objective:

• Identify the patient access methods within a hospital.

Intake… What is it All About?

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies patient intake methods utilized at the hospital.

Course Learning Objectives:

• Define intake.
• Identify intake sources.
• Name intake methods.

Demographics Learning Bundle

The Match Game

.50 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies MPI search steps to ensure the correct Patient is identified and medical record number assigned, if appropriate.

Course Learning Objectives:

• Define the master patient index.
• Apply the MPI search flow process.
• Identify the impact of an MPI search and assignment error.

The Key Players

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies the individuals for whom demographic information is obtained during the patient intake process.

Course Learning Objectives:

• Define demographic information.
• Name the key players and their roles in a Patient's visit.
• Differentiate between a Patient, Guarantor, Nearest Relative, Insured, and Emergency Contact.

Getting to Know You

.50 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies the key demographic elements that should be captured during patient intake.

Course Learning Objectives:

• Cite the "getting to know you" techniques.
• Identify demographic information that is gathered during patient intake.
• Apply the "getting to know you" techniques when gathering demographic information at patient intake.

All About the Key Players

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies information that should be obtained about the key players at the time of patient intake.

Course Learning Objectives:

• Identify the correct Guarantor, Nearest Relative, Insured(s), and Emergency Contact.
• Complete required demographic information for the Guarantor, Nearest Relative, Insured(s), and Emergency Contact.

Demographics - Oops!

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies what can happen if complete and correct demographic information is not obtained during patient intake.

Course Learning Objective:

• Recognize the impact incorrect demographic information has on several clinical and financial processes within the revenue cycle.

The Encounter Learning Bundle

Just What the Doctor Ordered

.50 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies the components of a complete physician order, types of physician orders, and the information obtained from a physician order.

Course Learning Objectives:

• Identify services that can be provided without a physician order.
• Cite the components of a complete physician order.
• Define physician order authentication methods.
• Name the methods physician orders are communicated.
• Select the key components on various inpatient and outpatient orders.
• Analyze a physician order and identify the missing key components.

Encounter Information of Another Kind

.75 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies encounter information gathered at patient intake.

Course Learning Objectives:

• Define the physician and clinical encounter information obtained during patient intake.
• Complete the physician and clinical encounter information associated with a visit.
• Define the visit specific encounter information obtained during patient intake.
• Complete the visit specific encounter information associated with a visit.

The Encounter - Oops!

.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies what can happen if complete and correct encounter information is not obtained during patient intake.

Course Learning Objective:

• Recognize the impact incorrect encounter information has on several clinical and financial processes within the revenue cycle.

Health Insurance Learning Bundle

Let's Play Cards

1.0 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course identifies information that is available on a Patient’s health insurance card.

Course Learning Objectives:

• Cite key payer information obtained from a health insurance card.
• Identify key payer information available on a Medicare card.
• Identify key payer information available on a TRICARE card.
• Identify key payer information available on a Blue Cross Blue Shield insurance card.
• Identify key payer information available on a commercial health insurance plan card.
• Identify key payer information available on a health maintenance organization card.
• Distinguish the differences between the five health insurance cards.

Medicare - World of Medicare

1.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces Medicare, a government health insurance program, through a CMS offered course entitled "World of Medicare."

Course Learning Objectives as documented in the World of Medicare course offered by CMS:

• State the purpose of Medicare.
• Describe the history of Medicare.
• Differentiate between Medicare Part A, Part B, and Medicare +Choice coverage.
• Describe the roles of agencies and contractors in the Medicare system.
• Describe the Medicare claims processing system.
• Describe the role of the provider in the Medicare system.
• Identify Medicare beneficiaries.
• Describe the Medicare benefit options for beneficiaries.
• Describe Medicare deductible and coinsurance beneficiary obligations.
• Identify the types of Medicare education resources available through your regional Medicare contractor.
• State the location of the Medicare Web-Based Training (WBT) courses.
• List the topics of the Medicare WBT courses.

Medicare - Front Office and Medicare

1.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces Medicare, a government health insurance program, through a CMS offered course entitled "Front Office and Medicare.

Course Learning Objectives as documented in the Front Office and Medicare course offered by CMS:

• Define Medicare.
• Describe the basic components of Medicare coverage.
• Differentiate between Medicare Part A, Part B, and Part C coverage.
• Describe the eligibility requirements for Medicare Part A and Part B.
• Identify the types of coverage available to a Medicare Beneficiary.
• Identify the three basic tasks for receiving a Medicare Patient prior to service.
• Define Medigap, Medicaid, and Crossover.
• Describe how a Beneficiary could be covered for medical expenses in addition to Medicare coverage.
• Determine if Medicare is the primary or secondary insurer for a Patient.
• Explain why a Written Advance Notice and a Medicare Development Letter are important and how to use them.

Medicaid - Michigan

1.0 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces Michigan Medicaid, a government health insurance program, through an online course offered by the State of Michigan.

Course Learning Objectives as documented in the Medicaid Managed Care course by Michigan Medicaid.

Gain an understanding of:

• What manged care is.
• What coverage is available under Michigan Medicaid Managed Care
• Who the partners are
• How the partners work together
• How the enrollment process works
• Who must, may, and may not enroll
• How beneficiaries enroll
• How the complaint process works

TRICARE and CHAMPVA

1.25 CEU credits by the National Association of Health Care Access Management (NAHAM)

Course Description: This course introduces TRICARE and CHAMPVA, two military health insurance programs.

Course Learning Objectives:

• Define TRICARE.
• Recognize benefit categorizes of eligible beneficiaries.
• Locate the TRICARE website as a reference tool.
• Define CHAMPVA.
• Recognize eligible beneficiaries
• Recognize the difference between TRICARE and CHAMPVA.
• Locate the CHAMPVA website as a reference tool.

Verification - Oops!

Course Description: This course identifies what can happen if verification of the demographic, payer, and encounter information is not completed.

What is Coordination of Benefits?