Revenue Cycle Management: Don't Get Lost In The Financial Maze

by Shawntea Moheiser, Kem Tolliver

Overview

How does the revenue cycle of a medical practice actually work? It is easy to get lost in all the phases of revenue management, so how does a practice keep it all straight? Proven solutions to optimize revenue cycle are the key, and this primer is a business-critical resource to deliver just that. Whether you're new to managing the revenue cycle or a seasoned professional, the concepts covered in these pages are key to your success

Product Details

ISBN-13:	9781568296777
Publisher:	Medical Group Management Association/Center for Research in Ambulatory Health Care Administration
Publication date:	04/16/2020
Pages:	472
Product dimensions:	6.00(w) x 9.00(h) x 0.95(d)

About the Author

Shawntea (Taya) Moheiser is the owner of
ITS Healthcare, LLC, a healthcare consulting company focused on innovation in healthcare management. Taya is the coauthor of MGMA's 2019 publication, "Revenue Cycle Management: Don't Get Lost in the Finance Maze", a contributing author to the Cleveland Clinic's 2018 publication, "Voices of Innovation", and is a past speaker for national and state MGMA conferences. Taya has developed and implemented national care coordination programs, managed multi-specialty organizations, and provided executive leadership across the industry.

Taya is a current member of MGMA's Government Affairs Council, MGMA's Advocacy Team, and MGMA's E&M Workgroup. Additionally, she has served on various state and national associations related to the improvement of healthcare management. She is the current President-Elect for Nebraska HIMSS and has held several positions on state legislative committees focused on industry improvement. Taya holds a bachelor's degree in Healthcare Management from Bellevue University and is currently seeking her master's degree in Healthcare Administration. Taya achieved CMPE status through MGMA and Certified Medical Office Management status through PMI.

In 2015, Taya was awarded the Governor's Volunteer Service Certificate from the State of Maryland based upon her efforts on the Maryland MGMA board and Maryland Physicians Association, MedChi. Taya's expertise is comprehensive throughout healthcare management with a special focus on revenue cycle management, operations compliance, and innovation in practice management. In her spare time she volunteers at Habitat for Humanity of Omaha, Omaha Lacrosse Club and Lauritzen Garden Guild.

Kem holds dual Bachelor of Science degrees in Healthcare Administration and Organizational Management, graduating Summa Cum Laude and Magna Cum Laude, respectively. Her certifications include: Certified Medical Practice Executive (CMPE), Certified Professional Coder (CPC) and Certified Medical Office Manager (CMOM). For over 20 years, she has provided strategic and operational leadership to medical practices and hospitals. Kem is the President of Medical Revenue Cycle Specialists, LLC (MRCS). Medical practices she's managed have received MGMA® "Better Performing Practice" distinctions in the areas of Accounts Receivable and Collections. The MRCS team managed the start up of over 20 new medical practices in seven years.

In a desire to lead, Kem served on the Board of Directors of MD MGMA as the Chair of the Practice Management Committee, Chair of the Government Affairs Committee. She received MD MGMA's 2016 Outstanding Service Award and served as the 2018 State of Maryland ACMPE Representative.

Kem has provided testimony and guidance on healthcare legislation within the Maryland General Assembly. Kem served as a member of Maryland's 2018 General Assembly House of Delegates - Health & Government Operations Prior Authorization special session workgroup. Kem provides Maryland state-wide risk management training programs for Medical Mutual Insurance policy holders. She served as an Adjunct Professor of Revenue Cycle at Catonsville Community College.

From 2017-18, Kem served on the Board of Directors for Laurel Regional Hospital. She was a Mentor for the Prince George's County Public School's 2018 PTECH Health Innovation Program. Kem served on the Totally Linking Care-Maryland Interoperability Advisory Council and the Novitas JL Carrier Advisory Committee. She is the Co-Founder of Prince George's County Practice Manager's Association and was nominated by Nexus Health, Fort Washington Medical Center for the 2016 Community Health Award. Kem was awarded with the State of Maryland Governor's Volunteer Service Certificate for 2015-18.

Table of Contents

Preface

Chapter 1: Defining the Revenue Cycle Model (RCM)

Chapter 2: Practice Preparation: Are You Planning to Fail?

Chapter 3: Scheduling & Pre-registration

Chapter 4: Eligibility, Referrals, & Authorizations

Chapter 5: Appointment Confirmations

Chapter 6: Check-In & Time of Service Collections

Chapter 7: Documentation & Coding Background for Managers

Chapter 8: Charge Entry

Chapter 9: Claims Preparation & Submission

Chapter 10: Deposit Management & Internal Controls

Chapter 11: Payment Posting

Chapter 12: Denial Management

Chapter 13: Insurance A/R Follow-Up

Chapter 14: Patient A/R & Follow Up

Chapter 15: Reporting

Chapter 16: Compliance & Risk Management within the Revenue Cycle

Chapter 17: Conducting an Internal Revenue Cycle Assessment

Chapter 18: Change Management

Appendices

Appendix A: Patient Demographics

Appendix B: Provider Credentialing Questionnaire

Appendix C: Preliminary RCM Questionnaire

Appendix D: Front Office Operations

Appendix E: Billing, Collections & Coding

Appendix F: Internal Refund Request Form

Appendix G: Financial Hardship Application

Appendix H: Electronic Health Record (EHR) Compatibility

Appendix I: Competency Standards Checklist

Glossary

Index

About the Authors