Revenue Cycle Management (RCM) is the lifeblood of any healthcare organization, encompassing all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. A well-optimized RCM process is crucial for financial stability, enabling healthcare providers to operate efficiently and focus on delivering high-quality patient care. This training course is designed to provide a comprehensive and practical understanding of the entire revenue cycle, from initial patient registration to final payment collection.

This program will equip participants with the skills to identify inefficiencies, reduce claim denials, and enhance their organization's financial performance. Through hands-on exercises and case studies, you will learn to navigate the complexities of medical coding, billing regulations, and patient collections. The course focuses on implementing best practices and leveraging technology to build a seamless and compliant revenue cycle that supports your organization's mission and improves its bottom line.

Duration

5 days

Target Audience

• Revenue cycle managers and supervisors
• Medical billing and coding specialists
• Hospital and clinic administrators
• Finance officers and controllers
• Patient access and registration staff
• Compliance and quality assurance officers
• Health information management professionals
• Practice managers
• Accounts receivable specialists
• Clinical documentation improvement (CDI) specialists

Objectives

• Understand the complete lifecycle of the healthcare revenue cycle.
• Analyze and optimize each stage of the revenue cycle for maximum efficiency.
• Master the principles of medical coding and clinical documentation.
• Reduce claim denials and accelerate reimbursement timelines.
• Develop effective patient billing and collection strategies.
• Ensure compliance with all relevant healthcare regulations.
• Utilize key performance indicators (KPIs) to measure and improve RCM performance.
• Implement technology and automation to streamline revenue processes.
• Foster inter-departmental collaboration to improve revenue outcomes.

Course Modules

Module 1: Fundamentals of the Revenue Cycle

• The definition and stages of the healthcare revenue cycle.
• The importance of a healthy revenue cycle for a healthcare organization.
• Key stakeholders and their roles in the RCM process.
• The link between clinical operations and financial performance.
• Identifying common challenges and opportunities in RCM.

Module 2: Patient Access and Preregistration

• Best practices for patient registration and data capture.
• The importance of accurate demographic and insurance information.
• Verifying patient insurance eligibility and benefits.
• The role of prior authorization in the revenue cycle.
• Patient financial counseling and point-of-service collections.

Module 3: Medical Coding and Clinical Documentation

• An overview of CPT, ICD-10, and HCPCS coding systems.
• The connection between clinical documentation and code selection.
• The importance of documentation for medical necessity.
• Understanding and applying coding guidelines and regulations.
• The role of a Certified Professional Coder (CPC) in the RCM.

Module 4: Claims Submission and Management

• The process of creating and submitting clean claims.
• Understanding different claim submission methods and clearinghouses.
• Strategies for identifying and preventing claim denials.
• Effective denial management and appeals processes.
• Tracking claims status and following up with payers.

Module 5: Patient Billing and Collections

• Principles of consumer-friendly patient billing statements.
• Developing a clear and compassionate patient collection policy.
• Navigating the complexities of patient payment plans.
• Understanding collection agency laws and regulations.
• Leveraging technology for automated patient communications and payments.

Module 6: RCM Compliance and Regulations

• The impact of HIPAA on the revenue cycle.
• Understanding fraud, waste, and abuse (FWA) regulations.
• Key audits and compliance reviews in healthcare.
• The role of an internal compliance program.
• Changes in healthcare policy and their effect on RCM.

Module 7: Performance Analytics and Improvement

• Defining and tracking key RCM metrics and KPIs.
• Using RCM dashboards and reporting for strategic decisions.
• Identifying bottlenecks and inefficiencies in the revenue cycle.
• Implementing process improvement methodologies.
• The future of RCM: predictive analytics and AI.

Training Approach

This course will be delivered by our skilled trainers who have vast knowledge and experience as expert professionals in the fields. The course is taught in English and through a mix of theory, practical activities, group discussion and case studies. Course manuals and additional training materials will be provided to the participants upon completion of the training.

Tailor-Made Course

This course can also be tailor-made to meet organization requirement. For further inquiries, please contact us on: Email: info@skillsforafrica.org, training@skillsforafrica.org Tel: +254 702 249 449

Training Venue

The training will be held at our Skills for Africa Training Institute Training Centre. We also offer training for a group at requested location all over the world. The course fee covers the course tuition, training materials, two break refreshments, and buffet lunch.

Visa application, travel expenses, airport transfers, dinners, accommodation, insurance, and other personal expenses are catered by the participant

Certification

Participants will be issued with Skills for Africa Training Institute certificate upon completion of this course.

Airport Pickup and Accommodation

Airport pickup and accommodation is arranged upon request. For booking contact our Training Coordinator through Email: info@skillsforafrica.org, training@skillsforafrica.org Tel: +254 702 249 449

Terms of Payment: Unless otherwise agreed between the two parties’ payment of the course fee should be done 7 working days before commencement of the training.