Revenue Cycle Management: Don’t Get Lost in The Financial Maze

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Revenue Cycle

SKU: 1008

Overview

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. 

Written by Shawntea Moheiser, CMPE, CMOM, and Kem Tolliver, CMPE, CPC, CMOM.

Interested in the Ebook version? Click here.


Shawntea (Taya) Moheiser

Shawntea (Taya) Moheiser, CMPE, CMOM

Owner, ITS Healthcare, LLC

Taya Moheiser, CMPE, CMOM, is a subject matter expert 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 and consults on all areas of healthcare operations including performance improvement, quality improvement, risk reduction and the shift to value-based payment methodologies. She has a passion for physician advocacy engaging in several terms on government affairs and legislative committees lobbying for healthcare improvement.
 
Moheiser serves on MGMA’s Government Affairs Council. In 2019 she coauthored MGMA’s publication on Revenue Cycle Management as well as had her thoughts on the innovative use of people and IT included in the HIMSS Voices of Innovation: Fulfilling the Promise of Information Technology in Healthcare, a publication coordinated by the Cleveland Clinic. Moheiser is a 2019 recipient of Midland’s Business Journal ‘40 Under 40’ Executives & Entrepreneurs Award.
 
Currently Moheiser is the President-Elect for Nebraska HIMSS. She also sits on two workgroups with MGMA that exist to provide feedback to CMS on proposed legislation. She is a speaker for state and national MGMA meetings and several rural health associations. In addition, she volunteers with Habitat for Humanity Omaha and Lauritzen Gardens on various committees, boards, and events.
 
Moheiser received her Bachelor of Science in Healthcare Management from Bellevue University where she graduated summa cum laude.
 



Kem Tolliver

Kem Tolliver, CMPE, CPC, CMOM

President, Medical Revenue Cycle Specialists

Kem Tolliver, the president of Medical Revenue Cycle Specialists, has provided strategic and operational leadership to medical practices and hospitals for more than 20 years. She is the coauthor of Revenue Cycle Management: Don’t Get Lost in the Financial Maze (MGMA: 2019).
 
From 2017 to 2018, Tolliver served on the board of directors for Laurel Regional Hospital. In a desire to lead, she served on the Maryland MGMA board of directors as the chair of the Government Affairs Committee and chair of the Practice Management Committee. She received Maryland MGMA’s 2016 Outstanding Service Award and was the 2018 State of Maryland ACMPE Certification Rep. MGMA awarded medical practices run by Tolliver with “Better Performing Practice” distinctions in the areas of accounts receivable and collections. She serves on the MGMA National E & M Workgroup and the Novitas JL Carrier Advisory Committee. Tolliver served on the Totally Linking Care-Maryland Advisory Council. She was a faculty member for Beyond the Exam Room and was an Adjunct Professor of Revenue Cycle at Catonsville Community College.
 
For more than 15 years Tolliver has provided expert testimony and guidance on healthcare legislation within the Maryland General Assembly. She served as a member of Maryland’s 2018 General Assembly House of Delegates – Health & Government Operations Prior Authorization special session workgroup. Tolliver provides state-wide risk management training programs for Medical Mutual Insurance policy holders. In addition, she serves as a subject matter expert for start-up behavioral-telehealth app and compliance officer for medical practices.
 
The State of Maryland awarded Tolliver the Governor’s Volunteer Service Certificate for 2015–2018. Nexus Health, Fort Washington Medical Center, nominated her for the 2016 Community Health Award. Heart to Hand, Inc. awarded Tolliver the 2019 Heart of Gold Award for 501 (c) (3) community-based public health medical practice leadership. She served as a mentor for the Prince George’s County Public School’s 2018 PTECH Health Innovation Program, the cofounder of the Prince George’s County Practice Managers Association and the 2020 President of Hyattsville/Prince George’s County American Academy of Professional Coders (AAPC).
 
Tolliver holds dual Bachelor of Science degrees in Healthcare Administration (summa cum laude) and Organizational Management (magna cum laude).


TABLE OF CONTENTS

Dedication

Acknowledgments 

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

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

Appendices

Glossary

Index

About the Authors

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