Improving Outcomes in Revenue Cycle Management

Course #HRC212016

Total Course Available CE Credits: 11.5 (all modules)


Course Directors:

Teresa C. Fugate, RN, BBA, CCM, CPHQ
Medicare STARS Strategic Consultant
Humana – Louisville, KY

Ronald L. Hirsch, MD, FACP, CHCQM
Vice President, Regulations and Education Group
Physician Advisory Services
Accretive Health – Chicago, IL


Description: Whether a healthcare organization is made up of several hospitals or one small private practice, revenue cycle management— the clinical and administrative management of claims, payment and revenue production—is a vital part of that organization’s success. This course explores the most important factors of RCM, from the overall parameters of operating revenues, the effects of the Affordable Care Act on RCM and the major players in the day-to-day business of RCM, such as Medicare, Medicaid and a wide range of commercial health plans. The course also explores the mechanics of appeals and denials, and how the transdisciplinary team can refine its procedures so that patients get the care they need while hospitals get the reimbursement they need.

Business goals: After completing this course case managers can expect to:
» Improve denial management and optimize payer reimbursements by 10%
» Reduce variances in patient treatment plans & reduce avoidable delays by 15%


Course Modules

Module A: Operating Revenues

Module B: Revenue Cycle Teams

Module C: Medicare Reimbursement

Module D: Medicare Performance

Module E: Commercial Reimbursement

Module F: Medicaid Reimbursement

Module G: Denials and Appeals

Module H: Cross Sector Interventions