Revenue Cycle Academy E-Learning
CONTENTS Revenue Cycle Fundamentals 3 Courseware Index 4 Certifications Patient Access... 6 Documentation & Charge Capture... 7 Billing & Collections... 8 Strategic Revenue Management... 9 E-Learning Packages ICD-10 Awareness and Competency Training Package...10 Patient Protection and Affordable Care Act (PPACA) Training Package...11 Medical Terminology Training Package...12 2
Revenue Cycle Fundamentals These courses address the knowledge and skill gaps that are most common among frontline revenue cycle employees, touching on topics that span the entire revenue cycle. Learners stay engaged with highly animated and interactive content that is not overly complex. Revenue Cycle: Big Picture Provides an overall look into the revenue cycle, including steps in a typical healthcare revenue cycle and what the main functional areas and key tasks of the revenue cycle are. Service Excellence Explains why providing excellent service is so critical to a healthcare organization s mission, including the difference between effective and ineffective verbal and non-verbal communication. Pre-Access: Maximizing the Beginning of the Revenue Cycle Focuses on key activities early in the revenue cycle that set the stage for overall revenue cycle success: scheduling, verifying insurance, obtaining authorization, and pre-registering scheduled patients. Patient Access: Enhancing the Patient Experience through Registration and Financial Clearance Highlights the levers for revenue cycle success once a patient arrives for service. This includes comprehensive registration, determining patient financial status, and collecting patient payments in a patient focused way. Point of Service Collections: Skills for Success Explores the situations that staff members find themselves in when collecting from patients. This includes ways to maximize collections and how to overcome patient objections. Case Management: Sealing the Gap between the Beginning and End of the Revenue Cycle Addresses how to effectively manage patient cases and correctly determine admission status. It also looks at best practices related to conducting concurrent reviews and executing utilization reviews. Documentation & Charge Capture: Translating Patient Care into Reimbursement Teaches the importance of ensuring accurate and timely clinical documentation, especially in the context of the looming ICD-10 conversion. The course also addresses best practices for capturing charges, and how to properly handle missing and late charges. Coding: Connecting Patient Care with Patient Financial Services Covers how medical coding fits into the revenue cycle. It looks at how coding is executed in a hospital setting, key best practices, and how medical coding will change in the future with the advent of ICD-10. Billing: Maximizing Claim Submission Across Payers Highlights how bills are generated and submitted. It also examines best practices for billing third party payers and how to effectively manage the outstanding balances reflected in the Accounts Receivable (A/R). Collections: Maximizing Reimbursement Across Payers Focuses on how to effectively collect outstanding balances from third party payers and patients. It also explores how to maximize an organization s relationship with external collection agencies, and the key legal aspects of collections. 3
Courseware Index Orientation Critical Data Elements Fundamentals Revenue Cycle: Big Picture Fundamentals Service Excellence HIPAA HIPAA Omnibus Rule Red Flags Rule Revenue Cycle: The Big Picture Service Excellence Understanding the 1500 Claim Form Understanding the UB-04 Patient Access Financial Clearance Financial Counseling Basics Maximizing COBRA Maximizing Financial Counseling Understanding and Assessing Patient Financial Status Insurance Verification and Validation ABN Overview Important Message from Medicare Overview Insurance Basics Insurance Plan Code Determination Medical Necessity Basics Medicare as Secondary Payer Service Authorization Basics Patient Information Collection Determining Financial & Medical Responsibility EMTALA Fundamentals Patient Access: Enhancing the Patient Experience Through Registration and Financial Clearance Fundamentals Pre-Access: Maximizing the Beginning of the Revenue Cycle Pre-Registration Basics Registration Basics Registration Skills for Success Point of Service Collections Fundamentals Point of Service Collections: Skills for Success Patient Liability Determination Patient Payment Basics Point of Service Collections: Skills for Success Scheduling Appointment Confirmation Order Management Basics Scheduling Basics Documentation & Charge Capture Case Management Admission Status Determination Case Management Basics Concurrent Review Basics Fundamentals Case Management: Sealing the Gap Between the Beginning and End of the Revenue Cycle RAC Review Management Utilization Review Basics Charge Capture Charge Capture Basics Managing Late and Missing Charges Understanding the Medicare 3-Day Payment Window Clinical Documentation Clinical Documentation Basics Fundamentals Documentation and Charge Capture: Translating Patient Care into Reimbursement Managing Clinical Documentation Managing Patient Records Medical Terminology Overview Medical Terminology: Blood and Lymphatic System Medical Terminology: Cardiovascular System Medical Terminology: Central Nervous System Medical Terminology: Digestive System Medical Terminology: Integumentary System Medical Terminology: Muscular System Medical Terminology: Reproductive System Medical Terminology: Respiratory System Medical Terminology: Skeletal System Medical Terminology: Urinary System Coding Coding Accuracy & Productivity Coding Basics Fundamentals Coding: Connecting Patient Care with Patient Financial Services ICD-9 and ICD 10: A Comparison and Contrast ICD 10: History and Overview Organization and Structure of ICD 10 Implementation The Impact of ICD 10: Healthcare Reimbursement The Impact of ICD 10: Physicians and Documentation The Impact of ICD 10: Revenue Cycle Departments DNFB Managing DNFB Accounts Billing & Collections Accounts Receivable Management A/R Analysis A/R Basics Coordination of Benefits Managing Uncollectible Accounts Self-Pay Receivable Stratification Agency Management Collection Agency Basics Maximizing Collection Agencies Billing Billing Basics Recently Released Courses Continued on Next Page > 4
Courseware Index (continued) Recently Released Courses Fundamentals Billing: Maximizing Claim Submissions Across Payers Patient Focused Billing Third Party Payer Billing Collections Fundamentals Collections: Maximizing Reimbursement Across Payers Legal Aspects of Collecting: Bankruptcy, Death and Divorce Legal Aspects of Collecting: Federal Regulations and Accident Liability Cases Self-Pay Collections: Skills for Success Third Party Follow-Up: Skills for Success Denials and Underpayments Denial Management Basics Denial Reporting and Accountability Payment Variance Identification and Resolution Strategic Revenue Management CDM and Pricing Charge Description Master Basics Charge Description Master Management Patient Payment Discounting Strategies Strategic Pricing Compliance An Overview and Background on the Patient Protection and Affordable Care Act (PPACA) Elements of a Compliance Plan Federal Agencies & Regulations that Influence the Healthcare Industry Global Impact of Healthcare Reform on Hospitals and Health Systems Secure and Effective Cashiering The Impact of Healthcare Reform: Changes to the Healthcare Reimbursement Model The Impact of Healthcare Reform: Proposed Changes in Health Insurance Coverage and Regulations The Impact of Healthcare Reform: Proposed Federal 501(r) Requirements for Non-Profit Hospital Organizations Understanding Accountable Care Organizations IT Integration Healthcare Information Systems - E-commerce & Data Warehousing Healthcare Information Systems - Functions & Management Meaningful Use Organizational Alignment Creating a Successful Revenue Cycle Staffing Model Forming a Winning Management Team Payer Contracting CMS Hospital Inpatient Prospective Payment System CMS Hospital Outpatient Prospective Payment System CMS Payment Rate Systems and Fee Schedules CMS Physician and Non-physician Practitioner Reimbursement CMS Reimbursement Methodologies Overview Healthcare Contracts Basics Health Maintenance Organizations Less Common CMS Prospective Payment Systems Managed Care Contracting and Reimbursement Managing Managed Care Contracts Medicare, Medicaid & SCHIP Performance Management and Audit Analytical Thinking Tools and Techniques Chalk Talks Flash Meetings Key Performance Indicators Motivation & Success Through Incentives Principles in Management: Coaching, Leadership & Negotiation Principles in Management: Communication & Change Productivity Measurement & Evaluation Setting Goals to Improve Performance 5
Patient Access Certification Certification Awarded: Certified Patient Access Professional (CPAP) Any frontline staff person in Patient Access who demonstrates potential to move into a more responsible position Frontline staff members, supervisors, or managers in other areas of the revenue cycle looking to move into a responsible Patient Access position Components of the Patient Access Certification: Orientation (6) Scheduling (3) Patient Information Collection (5) Insurance Verification and Validation (7) Financial Clearance (4) Residual Collections (3) Certification Courses Critical Data Elements HIPAA Red Flags Rule Service Excellence Understanding the 1500 Claim Form Understanding the UB-04 Financial Counseling Basics Maximizing COBRA Maximizing Financial Counseling Understanding and Assessing Patient Financial Status ABN Overview Important Message from Medicare Overview Insurance Basics Insurance Plan Code Determination Medical Necessity Basics Medicare as Secondary Payer Service Authorization Basics Determining Financial & Medical Responsibility EMTALA Pre-Registration Basics Revenue Cycle Academy Patient Access Certification This certificate recognizes that Jane Doe has successfully completed the Revenue Cycle Academy Patient Access Certification. Jane Doe is hereby considered a Certified Patient Access Professional (CPAP) for the period 1/9/2013 to 1/9/2015. COPYRIGHT HealTHCaRe BusIness InsIGHTs. all RIGHTs ReseRVeD. Registration Basics Registration Skills for Success Patient Liability Determination Patient Payment Basics Point of Service Collections: Skills for Success Appointment Confirmation Order Management Basics Scheduling Basics HBI E-Learning offers certifications structured around staff competency in each area of the revenue cycle. What makes us different: Everything is included materials, final exam, and certification processing No administrative work on your part we provide all course and exam enrollment Each certification consists of more than 20 courses in various primary processes documents, featuring best practice instructional treatments, such as Knowledge Checks 6
Documentation & Charge Capture Certification Certification Awarded: Certified Documentation & Charge Capture Professional (CDCCP) Any frontline staff person in a role that deals with health information who demonstrates potential to move into a more responsible position Frontline staff members, supervisors, or managers in other areas of the revenue cycle looking to move into a responsible health information position Components of the Documentation & Charge Capture Certification: Certification Courses Critical Data Elements HIPAA Red Flags Rule Service Excellence Understanding the 1500 Claim Form Understanding the UB-04 Admission Status Determination Case Management Basics Concurrent Review Basics RAC Review Management Utilization Review Basics Orientation (6) Charge Capture (3) Case Management (5) Coding (4) Clinical Documentation (3) DNFB (1) Charge Capture Basics Managing Late & Missing Charges Understanding the Medicare 3-Day Payment Window Clinical Documentation Basics Managing Clinical Documentation Revenue Cycle Academy Documentation & Charge Capture Certification This certificate recognizes that John Doe has successfully completed the Revenue Cycle Academy Documentation & Charge Capture Certification. John Doe is hereby considered a Certified Documentation & Charge Capture Professional (CDCCP) for the period 1/10/2013 to 1/10/2015. COPYRIGHT HealTHCaRe BusIness InsIGHTs. all RIGHTs ReseRVeD. Managing Patient Records Coding Accuracy & Productivity Coding Basics Getting Acquainted With ICD-10 Preparing for ICD-10 Managing DNFB Accounts HBI E-Learning offers certifications structured around staff competency in each area of the revenue cycle. What makes us different: Everything is included materials, final exam, and certification processing No administrative work on your part we provide all course and exam enrollment Each certification consists of more than 20 courses in various primary processes documents, featuring best practice instructional treatments, such as Knowledge Checks 7
Billing & Collections Certification Certification Awarded: Certified Billing & Collections Professional (CBCP) Any frontline staff person the Business Office who demonstrates potential to move into a more responsible position Frontline staff members, supervisors, or managers in other areas of the revenue cycle looking to move into a responsible position in the Business Office Components of the Billing & Collections Certification: Certification Courses Critical Data Elements HIPAA Red Flags Rule Service Excellence Understanding the 1500 Claim Form Understanding the UB-04 A/R Analysis A/R Basics Coordination of Benefits Managing Uncollectible Accounts Orientation (6) Billing (3) Collections (4) Denials and Underpayments (3) Accounts Receivables Management (5) Agency Management (2) Self-Pay Receivable Stratification Collection Agency Basics Maximizing Collection Agencies Billing Basics Patient Focused Billing Third Party Payer Billing Legal Aspects of Collecting: Bankruptcy, Death and Divorce Revenue Cycle Academy Billing & Collections Certification This certificate recognizes that Jane Doe has successfully completed the Revenue Cycle Academy Billing & Collections Certification. Jane Doe is hereby considered a Certified Billing & Collections Professional (CBCP) for the period 2/21/2013 to 2/21/2015. COPYRIGHT HealTHCaRe BusIness InsIGHTs. all RIGHTs ReseRVeD. Legal Aspects of Collecting: Federal Regulations and Accident/Liability Cases Self-Pay Collections: Skills for Success Third Party Follow-Up: Skills for Success Denial Management Basics Denial Reporting and Accountability Payment Variance Identification & Resolution HBI E-Learning offers certifications structured around staff competency in each area of the revenue cycle. What makes us different: Everything is included materials, final exam, and certification processing No administrative work on your part we provide all course and exam enrollment Each certification consists of more than 20 courses in various primary processes documents, featuring best practice instructional treatments, such as Knowledge Checks 8
Strategic Revenue Management Certification Certification Awarded: Certified Strategic Revenue Management Professional (CSRMP) Any revenue cycle management-level staff member who seeks a holistic grounding in key revenue cycle management and leadership topics Frontline staff members whose career goal is to achieve a management-level position in the revenue cycle Components of the Strategic Revenue Management Certification: Orientation (6) CDM and Pricing (4) Compliance (5) IT Integration (3) Revenue Cycle Academy Strategic Revenue Management Certification This certificate recognizes that John Doe has successfully completed the Revenue Cycle Academy Strategic Revenue Management Certification. John Doe is hereby considered a Certified Strategic Revenue Management Professional (CSRMP) for the period 2/5/2013 to 2/5/2015. COPYRIGHT HealTHCaRe BusIness InsIGHTs. all RIGHTs ReseRVeD. Organizational Alignment (2) Payer Contracting (11) Performance Management and Auditing (9) Certification Courses Critical Data Elements HIPAA Red Flags Rule Service Excellence Understanding the 1500 Claim Form Understanding the UB-04 Charge Description Master Basics Charge Description Master Management Patient Payment Discounting Strategies Strategic Pricing 501(r) Federal Requirements Elements of a Compliance Plan Federal Agencies & Regulations that Influence the Healthcare Industry Secure and Effective Cashiering Understanding Accountable Care Organizations Healthcare Information Systems - E-commerce & Data Warehousing Healthcare Information Systems - Functions & Management Meaningful Use Creating a Successful Revenue Cycle Staffing Model Health Maintenance Organizations Managed Care Contracting and Reimbursement Medicare, Medicaid & SCHIP Chalk Talks Flash Meetings Healthcare Contracts Basics Key Performance Indicators Motivation & Success Through Incentives Principles in Management: Communication & Change Productivity Measurement & Evaluation Setting Goals to Improve Performance HBI E-Learning offers certifications structured around staff competency in each area of the revenue cycle. What makes us different: Everything is included materials, final exam, and certification processing No administrative work on your part we provide all course and exam enrollment Each certification consists of more than 20 courses in various primary processes documents, featuring best practice instructional treatments, such as Knowledge Checks 9
ICD-10 Awareness and Competency Training Package Frontline staff members, supervisors, managers, or directors in all areas of the revenue cycle looking to enhance their knowledge on the transition to ICD-10. Components of the ICD-10 Awareness and Competency Training Package: A History and Overview of ICD-10 Examines the history of the ICD coding system, including the reason for the change to ICD-10 as well as the expected benefits to healthcare that this switch is intended to bring. ICD-9 and ICD-10: A Comparison and Contrast Explores the similarities and differences between ICD-9 and ICD-10 code sets, and how these differences are likely to impact everyday revenue cycle tasks. Structure and Organization of ICD-10 Implementation Looks at the steps that organizations can take to ensure compliance with the deadline, including an implementation timeline and changes to people, processes, and technology. The Impact of ICD-10: Revenue Cycle Departments Examines how ICD-10 will affect the revenue cycle team members in each revenue cycle function, from patient access to health information management to billing and collections. The Impact of ICD-10: Physicians and Documentation Studies how ICD-10 will impact the clinical documentation of services provided, and the need for more specificity in how physicians document their work. The Impact of ICD-10: Healthcare Reimbursement Specifically explores how the change to ICD-10 is projected to impact healthcare providers reimbursement and the processes involved in obtaining that reimbursement. Final Exam Upon completion of all courses, a comprehensive exam is made available which covers content from the six courses listed above. HBI E-Learning offers course packages that educate and create awareness among staff through an interrelated series of courses. What makes us different: Each course package contains 4 to 6 self-study courses that can be taken by all revenue cycle staff members Immediate enrollment with access to our advisory services and materials Our industry experts have developed these packages so you can expect the most timely and relevant information documents, featuring best practice design treatments 10
Patient Protection and Affordable Care Act (PPACA) Training Package Frontline staff members, supervisors, managers, or directors in all areas of the revenue cycle looking to enhance their knowledge of the Patient Protection and Affordable Care Act. Components of the PPACA Training Package: An Overview and Background on the Patient Protection and Affordable Care Act Provides an overview of the multiple components addressed within the PPACA, from community health needs assessments to meaningful use and the individual insurance mandate. The Global Impact of Healthcare Reform on Hospitals and Health Systems Explores specifically how reform could impact healthcare providers such as in terms of patient volumes and the patient experience as well as what these changes mean for organizations revenue cycle staff. The Impact of Healthcare Reform: Proposed Federal 501(r) Requirements for Non-Profit Hospital Organizations Examines the proposed IRS and Treasury requirements that non-profit hospitals must meet in order to retain their tax-exempt status, including regulations surrounding providers financial assistance policies. The Impact of Healthcare Reform: Proposed Changes in Health Insurance Coverage and Regulations Studies the ways in which the PPACA is changing the health insurance marketplace, including how individuals obtain healthcare coverage, what conditions and treatments are covered, and more. The Impact of Healthcare Reform: Changes to the Healthcare Reimbursement Model Explores how healthcare reform is changing the model in which healthcare services are paid, and the implications of insurers using quality of care to determine hospitals and health systems reimbursements. Final Exam Upon completion of all courses, a comprehensive exam is made available which covers content from the five courses listed above. HBI E-Learning offers course packages that educate and create awareness among staff through an interrelated series of courses. What makes us different: Each course package contains 4 to 6 self-study courses that can be taken by all revenue cycle staff members Immediate enrollment with access to our advisory services and materials Our industry experts have developed these packages so you can expect the most timely and relevant information documents, featuring best practice design treatments 11
Medical Terminology Training Package Any healthcare professional interested in learning the definitions and pronunciations of common medical terminology Components of the Medical Terminology Training Package: Overview The following courses cover pronunciation for key terms and conditions specific to each system of the human body Blood and Lymphatic Describes how the blood and lymphatic systems work together to transport waste and nutrients throughout the body Cardiovascular Reviews the different parts of the cardiovascular system, including the heart and blood vessels, and the functions they perform Central Nervous Examines the process and functions involved in transmitting signals throughout the body Digestive Illustrates each step of the digestive process, explaining how the digestive organs and glands work together to break down food Integumentary Explores the body s largest organ, covering the functions of each element in detail Muscular Looks at the different types of muscles and how they work together Reproductive Provides an understanding of the parts and functions of the male and female reproductive systems Respiratory Provides a detailed look at how the body uses oxygen, following the path air takes from inhalation to replenishing oxygen in cells Skeletal Describes the major bones and how they function to protect the body and work together for movement Urinary Illustrates how the body removes waste by looking at the organs and functions involved in each step of the process HBI E-Learning offers course packages that educate and create awareness among staff through an interrelated series of courses. What makes us different: Each course package contains several self-study courses that can be taken by all revenue cycle staff members Immediate enrollment with access to our advisory services and materials Our industry experts have developed these courses so you can expect the most timely and relevant information documents, featuring best practice design treatments 12
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