Revenue Cycle Management and Medical Billing for Advanced

• Course Overview
  • An intensive deep dive into the intricacies of healthcare revenue cycle management (RCM) and medical billing, designed for seasoned professionals seeking to elevate their expertise.
  • This advanced program focuses on strategic optimization, risk mitigation, and leadership within the RCM landscape, building upon foundational knowledge.
  • Explore the evolving payment models and regulatory frameworks that shape modern healthcare financial operations.
  • Gain a comprehensive understanding of the end-to-end revenue stream, from patient engagement to final payment and beyond.
  • This course empowers participants to drive significant improvements in financial performance and operational efficiency within their organizations.
• Requirements / Prerequisites
  • Solid foundational understanding of core medical billing principles and standard RCM processes is essential.
  • Prior experience in healthcare administration, finance, or coding is highly recommended.
  • Familiarity with basic healthcare terminology and common industry acronyms.
  • A keen analytical mindset and a desire to tackle complex financial challenges.
  • Participants should be prepared for advanced discussions and application of strategic concepts.
• Skills Covered / Tools Used
  • Strategic Contract Negotiation: Develop sophisticated strategies for negotiating with payers, understanding complex reimbursement structures, and safeguarding provider interests.
  • Underpayment Detection & Recovery: Master techniques for identifying and rectifying underpayments, implementing robust processes for claims review and aggressive recovery.
  • Advanced Coding & Documentation Integrity: Implement comprehensive audit protocols for coding accuracy, linking clinical documentation to appropriate billing codes for compliance and revenue optimization.
  • Enterprise-wide EDI Orchestration: Design and manage seamless electronic data interchange processes (837P/I, 835) across multiple systems and clearinghouses, ensuring data integrity and transaction efficiency.
  • Proactive Denial Management: Architect a strategic framework for minimizing claim denials by analyzing root causes, implementing preventative measures, and developing efficient appeal strategies.
  • Optimized Accounts Receivable Management: Implement advanced strategies for accelerating cash flow, prioritizing workload management, and escalating outstanding balances effectively.
  • Value-Based Care & Risk Adjustment Implementation: Leverage coding and documentation to impact quality metrics, risk adjustment factor (RAF) scores, and successfully navigate value-based payment models.
  • Automation & Analytics for RCM: Design and implement robotic process automation (RPA) solutions and utilize SQL/BI tools for advanced analytics, focusing on payment posting KPIs and trend analysis.
  • Governance & Enterprise Revenue Integrity: Establish robust governance frameworks and performance dashboards to ensure ongoing revenue integrity across the entire organization.
• Benefits / Outcomes
  • Attain the ability to architect and implement comprehensive revenue integrity programs that foster long-term financial health.
  • Develop the acumen to critically evaluate payer contracts and proactively identify opportunities for increased revenue capture.
  • Enhance the organization’s ability to adapt to and thrive in the landscape of value-based care and risk adjustment.
  • Become proficient in leading high-impact coding and documentation audits that directly influence financial outcomes.
  • Master the orchestration of complex EDI workflows, reducing manual intervention and errors.
  • Significantly reduce claim denial rates through strategic analysis and proactive intervention.
  • Drive substantial improvements in A/R days and overall cash acceleration.
  • Become a leader in leveraging technology and data analytics to transform RCM operations.
• PROS
  • Highly specialized curriculum: Focuses on advanced concepts and strategic thinking beyond foundational billing.
  • Actionable insights: Designed to equip participants with practical skills for immediate implementation.
  • Future-oriented: Addresses emerging trends in healthcare payment and delivery models.
  • Strong industry relevance: Reflects the current challenges and opportunities in US healthcare RCM.
  • Potential for leadership roles: Equips individuals with the skills to manage and lead RCM departments.
• CONS
  • Demanding workload: Requires significant commitment and prior knowledge to fully grasp advanced topics.

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