Master Revenue Cycle Management (RCM), Medical Billing, Insurance, AR, Denial Management, and Payment Posting
What you will learn
Gain a clear understanding of the US healthcare system, revenue cycle management (RCM), and its critical role in healthcare administration.
Learn the complete medical billing process, from patient registration to final payment posting, ensuring accuracy and efficiency at every step.
Acquire detailed knowledge of insurance types, including Medicare, Medicaid, Tricare, HMO, PPO, and POS plans, and understand their impact on billing and claims
Develop the skills to process claims, manage denials, and apply best practices to maximize reimbursements and minimize delays.
Build a solid foundation to launch or advance your career in medical billing, RCM, or healthcare operations with confidence and competence.
Why take this course?
Are you looking to build a solid foundation in Medical billing and revenue cycle management (RCM)?
This course is your comprehensive guide to mastering the essentials of RCM and medical billing, even if you’re starting from scratch.
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In this beginner-friendly course, you’ll:
- Gain a deep understanding of the healthcare system: Learn how the U.S. healthcare system operates, the importance of health insurance, and why RCM is essential for smooth operations.
- Distinguish between RCM and medical billing: Discover the key differences between these two vital aspects of healthcare finance and how they work together.
- Get familiar with insurance basics: Understand how different insurance plans, including Medicare, Medicaid, and private insurance, impact the billing process.
- Verify patient eligibility and benefits: Learn the step-by-step process of verifying insurance eligibility, benefits, and understanding referral requirements.
- Grasp medical coding essentials: Master ICD-10, CPT codes, and modifiers, and understand how accurate coding ensures proper reimbursement.
- Navigate the claim creation and submission process: Learn how to complete claim forms, work with practice management systems, and submit claims through clearinghouses.
- Manage Accounts Receivable (AR): Understand the key methods for AR follow-up, including aging buckets and best practices for efficient collections.
- Master denial management and appeals: Learn the steps to handle claim denials, rejections, and how to submit effective appeal requests.
- Understand payment processing: Dive into the process of payment posting, EOBs, ERA, and EFT to ensure timely and accurate payments.
By the end of this course, you’ll be equipped with the knowledge and skills needed to confidently manage the revenue cycle in any healthcare setting.
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Add-On Information:
- Course Overview
- Embark on an introductory journey into the vital world of healthcare revenue streams and financial operations.
- Demystify the complex interplay between patient care, administrative processes, and financial reimbursement within the U.S. healthcare landscape.
- Gain practical insights into the end-to-end financial lifecycle of a medical service, from initial patient engagement to the final resolution of payment.
- Understand the foundational principles that drive efficiency and profitability in healthcare organizations.
- This course is meticulously designed to equip individuals with the core competencies required to navigate and succeed in medical billing and revenue cycle management.
- Requirements / Prerequisites
- No prior experience in healthcare administration or billing is necessary.
- A foundational understanding of basic computer literacy is beneficial.
- A commitment to learning and attention to detail is essential for success.
- Familiarity with general office administrative tasks is an advantage.
- Access to a computer with internet connectivity for course materials and potential simulations.
- Skills Covered / Tools Used
- Proficiency in interpreting medical codes (ICD-10, CPT, HCPCS) for accurate claim submission.
- Ability to navigate and utilize Electronic Health Record (EHR) and practice management software interfaces.
- Skills in claim scrubbing and identifying potential errors prior to submission.
- Understanding of payer portals and their role in claim status inquiries and adjustments.
- Development of effective communication strategies for patient billing inquiries and payment arrangements.
- Familiarity with regulatory compliance standards relevant to medical billing (e.g., HIPAA).
- Hands-on practice with common medical billing software functionalities (specific software may vary based on curriculum focus).
- Benefits / Outcomes
- Become a sought-after professional in a growing and stable industry.
- Develop a marketable skill set applicable across various healthcare settings, including hospitals, clinics, and specialized practices.
- Empower yourself to contribute directly to the financial health of healthcare providers.
- Gain the confidence to perform essential billing and RCM tasks with accuracy and speed.
- Open doors to entry-level positions and potential pathways for career advancement within healthcare administration.
- Acquire the knowledge to effectively manage patient accounts and resolve payment discrepancies.
- Build a strong foundation for further specialization in areas like coding, auditing, or RCM analytics.
- PROS
- Provides a clear, step-by-step introduction to a complex field.
- Focuses on practical skills immediately applicable in a professional setting.
- Opens pathways to a consistently in-demand career.
- CONS
- As a beginner course, it will not cover advanced RCM strategies or highly specialized billing scenarios.
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