Revenue Cycle Management
COURSE SUMMARY & OBJECTIVES
Revenue Cycle Management aims to improve the patient accounting practices towards error free profitable billing, smart occupancy management, and economic utilization of hospital recourses.
- Understand internal and external factors within the healthcare setting:
- Theoretical understanding of Revenue Cycle Management components
- Practical understanding of Revenue Cycle Management
WHO SHOULD ATTEND:
Healthcare professionals working in hospitals, health centers and insurance companies wanting to understand the Revenue Cycle Management process including without limitation:
- Admission, reception and customer service
- Administrative staff including approvals, claims processing, medical coding, rejection analysis and utilization review
- Finance staff including billing, collection, costing, pricing and experts of actuarial & underwriting departments
- Medical staff including case management, customer service, HIM, health informatics and physician assistants
- Managers
- Senior Executives
COURSE FEE:
USD1,300
(10% discount available for DHA members - please Contact Us for further information)
CONTACT US
For further information, please send your inquiry to ritchel.leonora@tri-c-academy.com.
COURSE OUTLINE:
Level 1: Revenue Cycle Management Conceptual & Process Knowledge
Training duration: 30 hours
1. Healthcare System Components and Dynamics
2. Health Insurance Companies
3. RCM Setup for HCOs
4. RCM 24 Processes in HCOs
5. RCM Benchmarking & Quality Improvement
6. 7 Strategic Velocities for Patient-centric & Profitable RCM
7. Holistic Approach for RCM Clinical Integration
Revenue Cycle Management
COURSE SUBJECTS:
Session 1: Healthcare System Components and Dynamics -Dr. Adel Olleik
1. Healthcare System (HCS) sustainable development goals (SDGs)
2. HCS Players:
a) Providers: Promotion, Prevention, Treatment (Healthcare Organizations- HCOs & Doctors), & Rehabilitation
b) Payers: Public, Social Insurance, Private insurance, Mutual fund, Managed Care Practices & HMOs
c) Regulators: HCS & universal coverage policies, standardization, coding, pricing, payment systems, & pay for performance (P4P) incentives
3. HC Power Game
4. Trends in Healthcare Economics: Cost control & payment systems
5. Exercise: describe & criticize a selected HCS
Session 2: Health Insurance Companies - Mr. Samer Hanna
1. Insurance and re-insurance companies overview
2. Risk pooling & solidarity
3. Health insurance companies’ services model
a) Actuarial studies for risk assessment and underwriting
b) Issuance of insurance policies: Eligibility, Tables of benefits, Includes, and Limits
c) Provider network and contracts management
d) Approvals management
e) Claim processing and denials
f) Payment and reconciliation
4. Exercise: describe health insurance companies services from a patient & hospital perspective in a selected country
Session 3: RCM Setup for HCOs - Dr. Adel Olleik
1. Codification of hospital diagnosis & Procedures (ICD & CPT)
2. Service costing and pricing
3. Payment systems: fee-for-service, global rates, DRGs.
4. Exercise 1: Describe codification, pricing, & payment systems in a selected country, & explain benefits of national unification of these practices by regulators
Session 4: RCM 24 Steps in HCO's (Part 1) - Dr. Adel Olleik
1. RCM 24 step from service offering to accounts settlement
2. Common gaps in every step
3. RCM step indicators
Session 5: RCM 24 Steps in HCO's (Part 2) - Dr. Adel Olleik
1. RCM 24 step from service offering to accounts settlement
2. Common gaps in every step
3. RCM step indicators
Session 6: RCM 24 Benchmarking & Quality Improvement - Mr. Samer Hanna
1. Data Identification & Analysis for Performance Measuring
2. RCM Staff & Doctors performance dashboards
3. International benchmarking using HFMA 29 indicators
4. Integrated quality improvement process for RCM
5. Exercise1: Case Study, for Identify gaps in RCM in a simulated organization, analyze, design resolutions, and post on Performance Improvement Log (PIL)
6. Exercise 2: claims scrubbing, and denials analysis of sampled real anonymous claims
Session 7: 5 Strategic Veolcities for Patient-centric & Profitable RCM (Part 1) - Dr. Adel Olleik
1. Governance, organization & competencies for RCM
2. Case Management for patient-centric RCM
3. Electronic RCM: EMR & ERP Integration
4. Revenue budgeting
5. Exercise 1: Case Study, for revamping RCM to comply with 7 Strategic velocities
Session 8: 5 Strategic Veolcities for Patient-centric & Profitable RCM (Part 2)- Dr. Adel Olleik
6. Capacity, Utilization & Productivity Management
7. Exercise 2: Capacity calculations and optimization, Effective bed occupancy management, & developing performance indicators for doctors & Case Mangers.
Session 9: Holistic Approach for RCM Clinical Integration - Dr. Adel Olleik
1. Clinically- Driven RCM: Clinical pathways, Coding, Costing, Rules engines, Ordering, Approvals, Utilization, Supply chain, & Denials
2. Doctors’ practice integration: contracts & performance dashboards for Win-Win relations
3. Interprofessional teams (IPT)& Allied Health System (AHS) integration with RCM
4. RCM Sustainability: Quantum Leadership & Innovation
