Revenue Cycle Concepts Program

IRM's RCC II course includes four lessons: Authorizations, History of Healthcare Reimbursement, Eligibility and Verification, and Confidentiality Registration Regulations.

• Since the inception of Managed Care, authorizations are required for most nonroutine tests. These authorizations must be obtained prior to services being performed in order to secure payment. The party responsible for payment issues authorizations. For example, in a PPO plan, the insurance carrier issues the authorization. For an HMO plan, it would depend on the type of service, as the HMO contract defines payer responsibility. This session will help student to know the process for obtaining and verifying authorizations.
• To better understand managed care, it is helpful to review the history of health insurance. IRM's History of Healthcare Reimbursement will provide information about different health plan products and how benefits vary between plan types.
• The process of checking a patient’s insurance eligibility prior to a hospital visit is a critical step in a hospital’s revenue cycle. If not done properly, the lack of complete information can result in billing errors, insurance coverage concerns and delays in payment or no payment at all. Eligibility and Verfication will assist the hospital with documentation integrity steer patient care and revenue cycle in the right direction.
• Confidentiality and Registration Regulations introduces the student to the various governmental agencies that formulate and oversee healthcare policies. It also familiarizes the student with the concepts of privacy, confidentiality, and applicable regulations.

IRM's RCC III course includes five lessons: Third Party Liability, Effective Follow-Up and Collections, Liens, Unbilled Accounts, and Contract Analysis.

• Third Party Liability provides the student with the ability to screen cases for third party liability (TPL). TPL refers to situations where someone is injured and another party is responsible for the payment of services. In most cases, the third party payer is usually one of the following: an automobile insurance and workers' compensation. Work-related injuries are reviewed in a separate lesson, but the identification and handling of third party situations will be discussed here. The first indication of a TPL case comes from the patient interview during registration. Being alert to patient descriptions of injuries or diagnoses will ensure correct billing. The simple question, “Is your injury related to an accident?” should be standard in the registration process. From there, the registrar can confirm TPL situations.
• The collection process and the auditing process go hand in hand, both being equally important. In this lesson, the student will be introduced to the tools necessary to collect on accounts by using worksheets and reports in the Managed Care Software application. Crucial information is provided on techniques used to effectively contact the provider or insurance carrier as well as on the appeal process on denied accounts.
• Liens provides the student with a basic overview of the complicated subject of medical liens. A medical lien is the right of a hospital, doctor, or healthcare provider to assert an interest in personal injury recoveries to the extent of the cost of the treatment or service provided. The lesson provides information about the identification and filing process of liens, which situations they apply for, and what the regulations related to liens are. It also discusses a variety of lien types and how the lien payment will be distributed.
• Unbilled Accounts provides the student with the understanding of unbilled accounts and the tools and thought processes needed to reduce their number.
• Contract Analysis provides an understanding of the importance of being able to read and correctly interpret payer contracts. Standard language and conventions used in contract writing are examined in adition to information in the body of the contract.

IRM's RCC IV course includes four courses: Workers' Compensation, Workers' Compensation Georgia, Coordination of Benefits, and Bill Presentation.

• The purpose of our Workers' Compensation lesson is to give the student a general overview of workers’ compensation programs and their unique requirements. This lesson will help the student learn primarily about workers’ compensation in particular states within the U.S.A.
• Workers' Compensation Georgia will provide a general overview of workers’ compensation programs and its unique requirements. It is important to recognize that every state has its own specific legislative guidelines and reimbursement rates. A good portion of information in this course is derived from the Georgia State Board of Workers’ Compensation.
• Most people would probably agree that Coordination of Benefits (COB) does not make for the most scintillating of dinner conversations. Understanding the issues involved with COB is, however, a crucial part in ensuring the hospital receives accurate and adequate reimbursement in a timely manner for services rendered. This lesson covers this complex topic and familiarizes the student with Medicare secondary payer provisions and third party liability while providing an in-depth look at all issues related to COB.
• Revenue management can not be done without examining and understanding billing documentation. Even the most efficient clinical and administrative processes in a hospital will not be effective if the bill presentation is inaccurate or not sufficiently understood by those involved in billing and auditing charges or payments. This lesson provides an in-depth look at the components of both the itemized bill and the UB-04 to equip you with the necessary understanding of those crucial documents.

IRM's RCC V Course includes two lessons: Medical Terminology and Coding and Medicare Compliance.

• Medical Terminology and Coding provides an overview of basic medical terminology, coding, and the effect that coding has on both the registration and the billing processes.
• Medicare Compliance introduces the Medicare program. It provides a historical perspective and information on how to currently access information on the program and how to remain Medicare compliant.

IRM's RCC VI course contains two lessons: Hospital Information Systems and Information Systems Report Writing.

• Hospital Information Systems provides an understanding of the many different systems used in a hospital to track the patient care provided, as well as how to submit a claim to the insurance payers for the services provided. It is important for every employee of the hospital to understand the complexity of the computer systems in use. This lesson will provide the student with an overview of typical systems found in acute healthcare facilities.
• Information Systems Report Writing provides the student with an understanding of key concepts in requesting reports from the Hospital Information System (HIS).