Medical Billing and Revenue Cycle Management
This training provides a comprehensive overview of the medical billing process and revenue cycle management. Participants will learn how to accurately process medical claims, manage patient accounts, and navigate insurance regulations. This course emphasizes the importance of accurate billing, timely claims submission, and effective revenue cycle management.
Target Audience: This course is designed for individuals seeking entry-level positions in medical billing, including aspiring medical billers, healthcare administrators, and those looking to understand the revenue cycle process.
Program Outlines
Module 1: Introduction to Medical Billing and Revenue Cycle
Overview of the healthcare revenue cycle
Key components of medical billing and claims processing
Roles and responsibilities of a medical biller
Module 2: Medical Billing Process
Patient registration and insurance verification
Charge capture and coding linkage
Preparing and submitting medical claims
Module 3: Insurance and Payer Systems
Understanding private insurance, Medicare, and Medicaid
Insurance eligibility and benefits verification
Common payer rules and billing requirements
Module 4: Claims Management and Follow-up
Electronic claims submission and clearinghouses
Handling claim denials and rejections
Appeals process and effective follow-up strategies
Module 5: Patient Accounts and Payment Posting
Managing patient billing statements
Payment posting and reconciliation
Handling patient inquiries and collections
Module 6: Compliance and Regulatory Requirements
HIPAA and patient privacy regulations
Fraud, abuse, and compliance in medical billing
Auditing and documentation best practices
Module 7: Revenue Cycle Optimization
Identifying bottlenecks and improving cash flow
Metrics and key performance indicators in revenue cycle management
Technology and automation tools in billing
Module 8: Practical Exercises and Case Studies
Real-world billing scenarios and problem-solving
Hands-on practice with billing software simulations
Group discussions and continuous feedback