Print ISBN # 978-1-56829-677-7
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.
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Taya Moheiser, CMPE, CMOM, is a subject matter expert (SME) in healthcare compliance, organizational governance, process optimization and revenue cycle management. She has held senior-level executive management positions in private practices, collaborative institutes and national care coordination organizations. Taya consults on all areas of healthcare operations including performance improvement, quality improvement, risk reduction and the shift to value-based payment methodologies.
Taya has served on MGMA’s Government Affairs Council and recently co-authored Revenue Cycle Management: Don’t Get Lost in the Financial Maze. Taya graduated summa cum laude from Bellevue University with a bachelor of science in healthcare management, and she is seeking an executive healthcare MBA from Creighton University. Taya also is the current president of Nebraska HIMSS and sits on two workgroups with MGMA that provide feedback to CMS on proposed legislation. Taya is a frequent speaker for state and national MGMA meetings as well as several rural health associations.
Kem Tolliver a public speaker, co-host of the RevDive podcast and co-author of Revenue Cycle Management: Don't Get Lost in the Financial Maze. Medical practices managed by Kem have received MGMA Better Performer distinctions in the areas of A/R and collections.
As president of Medical Revenue Cycle Specialists, LLC, she and her team lead healthcare organizations in practice startup and transformation, revenue cycle improvements, clinical documentation improvement, educational programming, payer contracting, HIT software development, EHR/PM software customization, risk management and telehealth integration.
With a desire to impact public health, she offers strategies to CINs, ACOs and MCOs on interoperability, clinical workflow redesign and transitional care management. She has bachelor of science degrees in healthcare administration and organization management, with summa cum laude and magna cum laude distinctions, from Washington Adventist University.
Maintaining board certifications from AAPC, MGMA and PMI allows Kem to be an industry thought leader who is called upon to provide strategic guidance on regulatory and operational improvement outcomes. She has served on the Board of Directors at Laurel Regional Hospital, as well as on the Board of Directors of Maryland MGMA as the chair of the Government Affairs Committee and the State of Maryland’s ACMPE Certification Rep. Kem is the President of the PG County Chapter of AAPC.
TABLE OF CONTENTS
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
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
Chapter 17: Conducting an Internal Revenue Cycle Assessment
Chapter 18: Change Management
About the Authors
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