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Hospitals and Other Providers

Career level:


Recommended for:

Patient Access
Patient Financial Services
Revenue Cycle

Delivery Method:

Self Study

Advance Preparation:




Course Availability:

18 Months

How To | Denials Management
Distinguishing coding denials from clinical validation denials is an ongoing challenge, and a good place to review processes.
How To | Denials Management
Root causes for denials should be defined operationally to determine the level of analysis required internally.
How To | Denials Management
Coders need to understand billing expectations, how the billing process works and how the revenue cycle is affected.
How To | Denials Management
Successful denial management and prevention strategies require the right mix of people capable of handling the process from beginning to end.
Course | Intermediate | Denials Management
This course explains how improving management of the claims denial process can have a positive effect on a hospital's bottom line. It presents best practices that will help to capture a significantly higher proportion of claims and increase...
Course | Advanced | Denials Management

Revenue Cycle Performance Improvement

Course | Advanced | Denials Management

Revenue Cycle Performance Improvement


This course introduces the idea that lasting performance improvement in the revenue cycle can only be achieved after changing the work culture. The course also describes the ambulatory payment classification (APC) system introduced by the Centers for Medicare and Medicaid Services (CMS) in 2000. It also explains the importance of correct charging in avoiding denials, overcharges, and undercharges and describes how hospitals can prevent inaccurate charging before claims are submitted to payers and how hospitals can use retrospective audits to recover lost revenue from previously paid claims.

Estimated course completion time: 2 hours
After this program, you'll be able to..
  • Recognize the cultural issues underlying the frequent failure of performance improvement initiatives in the revenue cycle
  • Recognize how to assess the current work culture
  • List the basic steps to take to change the work culture
  • Identify the kinds of training that are most effective in changing the work culture
  • Recognize how to provide support for employees throughout the redesigned revenue cycle
  • Recognize the kinds of mechanisms that can be put in place to sustain the new environment
  • Recognize the importance of accurate coding and of updating the charge description master (CDM) quarterly
  • Recognize the importance of breaking down communication barriers among outpatient departments to reduce the rate of errors
  • Identify the information system capabilities that are needed to strengthen payment under the OPPS
  • List the basic steps to take to change the work culture
  • Identify how inaccurate charging affects a hospital's bottom line
  • Identify strategies hospitals are using in clinical and ancillary departments to ensure accurate documentation and charging
  • Recognize the benefit of concurrent charge auditing, or auditing claims before they are submitted to payers
  • Recognize the potential impact of retrospective charge audits, or reviewing already paid claims
  • Summarize the challenges involved in identifying and collecting self-pay portions from patients
  • Recognize how much self-pay portions contribute to a hospital's bottom line
  • Recognize how to collect self-pay portions from insured patients
  • Recognize how to identify and help patients who cannot pay for healthcare services

Related Courses | Denials Management

On Demand Webinar | Overview | Revenue Cycle

Use the butterfly effect to prevent denials, improve financial results

A butterfly flaps its wings, causing a hurricane halfway around the world.  Learn how to apply the butterfly effect by making minor changes in the front-end of your revenue cycle to eliminate denials, increase POS collections and improve patient satisfaction, causing minor financial improvements.

We'll breakdown how Magnolia Regional Health Center used the butterfly effect to impact patient access, leading to a 50% reduction in denials, 600% increase in cash collections and 90th percentile in patient satisfaction. You'll learn how to put the butterfly effect to work in the front-end of your revenue cycle.

Original Live Webinar Date:  4/7/20

On Demand Webinar | Intermediate | Revenue Cycle

Denial management and prevention: What is the difference and why you need both

Working denials is costly, it delays collections and uses valuable and expensive resource time.

The webinar will cover the process and analytics needed to identify denials that are preventable, how to work within your organization to assign actions needed to prevent denials and how to continuously measure and monitor data and workflows to increase clean claims.

We also cover how to develop and implement a denial management plan, using reporting, analytics, technology, measuring, monitoring and communication to reduce denial and appeal turnaround time, decreasing days in A/R, timely filing and appeal denials.

The subject will be presented from three perspectives: billing operations, front-end operations and analytics development.

You will be introduced to a 12-step program for developing and implementing your own denial prevention and management plan.

Course | Basic | Patient Access

Importance of Insurance Verification

In this course we highlight the various types of health insurance that your patients may present at registration. We'll review the fundamentals of Medicare, Medicaid, and third-party liability plans. You'll learn how verifying a patient's insurance eligibility and benefits affect the coordination of benefits process, which determines the primary payer and secondary payer on a claim.

Estimated course completion data: 30 minutes

Course | Intermediate | Denials Management

Successfully Appealing Denials

This course explains how improving management of the claims denial process can have a positive effect on a hospital's bottom line. It presents best practices that will help to capture a significantly higher proportion of claims and increase collections, including steps and strategies for successful appeals.

Estimated course completion time: 3 hours