• Certified Professional Coder (15 weeks)
  • [link here for those interested]

Designed for individuals currently working in the revenue cycle

• Certified Rural Health Clinic Professional (8-10 weeks)
  • [link here for those interested]

Designed for directors, clinic administration or other RHC professionals

“A Bird’s Eye View” Beginner Level (Webinar -1 hour) (recording available)

• Identify types of denial
• List the steps to working the A/R
• Understand patient collection practices
• Review the bankruptcy concepts 

“The Buck Starts Here” Intermediate Level (Seminar - 3 hours)

What is Revenue Cycle Management in Healthcare?

Seven Steps to follow:

1. Preregistration
2. Registration
   • Patient Registration “The Buck Starts Here”
     • Identify patient types for registration purposes
     • List demographic and insurance information required for the registration process
     • Understand the process for verifying insurance coverage
     • Read and apply information on the insurance card

3. Charge Capture
4. Claim Submission
5. Remittance Processing
6. Insurance Follow up
7. Patient collections 

“I OBJECT” Advanced Level (Workshop – 4 hours)

Denial Management Process in Healthcare 

Learning Objectives/Agenda:

• Understanding the Denial Management Process
• Common Causes of Denials
• The Impact of Poor Denial Management on Revenue Cycle Efficiency
• Streamlining Denial Management Process with Technology
• Using Analytics to Identify Denial Trends and Patterns
• Implementing Best Practices for Denial Prevention
• Strategies for Effective Denial Appeals
• Collaborating with Payers to Improve the Denial Management Process
• Measuring Denial Management Performance and Outcomes
• Conclusion: The Importance of Continuous Improvement in Denial Management Participants will bring their top denials.

There will also be samples of top denials available.  Go through the actual process of an appeal for those denials from start to finish.  

“People vs Payers” Advanced Level (Workshop – 4 hours)

Payer Specific Denials 

Learning Objectives/Agenda:

Health Insurance Models

• Understand health maintenance organizations (HMO) and models
• List and describe types of managed care organizations (MCO)
• Provide an overview of government payers
• Explain and identify consumer driven health plans (CDHP)
• Discuss an overview of Workers’ Compensation and Liability Insurance
• Understand the role of utilization review organizations (URO)

Gov’t Carriers (Medicare, Medicaid, Tricare)

• Explain Medicare eligibility requirements
• Identify the different parts of Medicare and what is covered under each
• Explain Medicaid eligibility requirements and coverage
• List Medigap coverage and claims filing requirements
• Identify TRICARE coverage and claims filing requirements

Blue Cross Blue Shield

• Common Types of Insurance Plans
• Contractual Requirements
• Provider Manuals
• Claims Filing Requirements
• EOB
• Common Denials
• Appeals

Commercial Insurance

• Understanding common denials from insurance companies
• Explain the appeals process for Aetna, UnitedHealthcare, and Cigna

Worker’s Compensation Billing

• Defining a physician fee schedule
• Reviewing processes to avoid delinquent claims
• Discussing accounts receivable deposit balancing
• Understanding electronic claims submissions
• Discussing facility billing Hands-on activity will be with Denials related to specific payer and their billing guidelines.