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

Book -

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. 

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 (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

Kem Tolliver, CMPE, CPC, CMOM

President, Medical Revenue Cycle Specialists, LLC

Kem Tolliver is a regional and national healthcare thought leader, public speaker 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. 

Kem has provided strategic and operational leadership to medical practices and hospitals for more than 20 years. As president of Medical Revenue Cycle Specialists, LLC (MRCS), her team leads healthcare organizations in practice startup and transformation, revenue cycle improvements, clinical documentation improvement, educational programming, payer contracting, HIT software development, EHR/PM software customization and telehealth integration. 

Kem graduated summa cum laude and magna cum laude, respectively, with dual bachelor of science degrees in healthcare administration and organization management from Washington Adventist University. 

Kem previously served on the Board of Directors of Maryland MGMA and as the chair of the Practice Management Committee and chair of the Government Affairs Committee. She received MDMGMA's 2016 Outstanding Service Award and was the 2018 State of Maryland ACMPE Certification Rep.


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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