HIT 215 - Revenue Cycle Management

 
Description
This course presents an introduction to revenue cycle management, including reimbursement methodologies for inpatient, ambulatory and professional settings. Students learn diagnosis-related group (DRG) calculation, Ambulatory Payment Classifications (APCs), relative value units (RVUs) and fee schedules, health insurance claims, terminology, reimbursement methodologies, completion of billing forms and compliance with regulatory requirements.  The students complete the review of Certified Revenue Cycle Representative (CRCR) study guide during the final four weeks of class. 

1. Evaluate the revenue cycle process.
2. Generate insurance payment calculations and claims.
3. Assess compliance with regulatory requirements.
4. Apply revenue cycle technology.

1. Payment methodologies
2. Revenue cycle detail
3. Regulatory requirements, overview of legal aspects
4. Chargemaster maintenance, payer negotiation, denials management 
5. Contracting and credentialing
6. Key Performance Indicators (KPIs) and benchmarking
7. Clearinghouse integration and electronic health record (EHR) use

• Information Literacy
• Technological Competence

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