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.  

1. Implement required changes to revenue cycle based on payer requirements. 
2. Generate insurance payment calculations and claims.
3. Navigate Centers for Medicare and Medicaid Services (CMS) and other payer portals.
4. Apply reimbursement methodologies and payment systems.
5. Evaluate coding, billing and documentation problems to increase reimbursement. 
6. Identify financial imperitives facing the healthcare system and best practices. 

1. Payment methodologies
2. Revenue cycle detail
3. Regulatory changes
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
8. CMS
9. Accounts receivables follow up

• Information Literacy
• Technological Competence

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