The Revenue Integrity Training Toolkit Elizabeth Lamkin, MHA, ACHE The revenue cycle in a hospital or health system is a continuum, and each department and role within the cycle has to work in unison to be successful. Due to the nature of today's healthcare environment some staff may not even realize that they're part of the revenue cycle. If there's a weak link, the entire system can quickly be in trouble due to issues with compliance, reimbursement, and, ultimately, patient care. This handbook will help get everyone, from billers to clinicians, on the same page improving systemic information flow and feedback loops. This toolkit comes with five handbooks that you can give to members of the revenue cycle. Bulk pricing for these handbooks is also available. In addition to the handbook, you will receive: Downloadable flow charts depicting the overarching revenue cycle and its various components and information flow Diagram of best practice committee and communication structures to help ensure a single high-functioning revenue cycle A sample payer scorecard to help track payer performance and support internal accountability Customizable team charter template for a medical records improvement committee A list of helpful resources for all aspects and departments involved in the revenue cycle Table of Contents Chapter 1: Revenue Cycle Integrity: A System Enterprise The Revenue Cycle Plan Chapter 2: Other Roles and Responsibilities Hospital Departments Hospital and Medical Staff Leader Chapter 3: Cross Functional Management of Revenue Cycle Committee Structure and Information Flow Communication and Education Outcome Measurement and Reporting for Accountability Chapter 4: Summary This handbook will help you: Recognize how all of the different pieces of the revenue cycle fit together Reduce inconsistencies and increase buy-in across departments Identify key players in the revenue cycle Create and manage revenue cycle committees that produce measurable results and improve financial accountability Engage key stakeholders in education and help them tie overarching revenue cycle goals with specific departmental goals

Prevent Denials and Win Appeals: The Hospital Case Manager's Guide to Revenue Integrity Paul Arias, RN, BSN, MIS Optimizing revenue integrity and turning denied claims into payments just got easier. Using actual case studies, proven reporting methods, and evidence-based information, this book and CD-ROM package will show you how to prevent denials on the front end by managing level-of-care decisions, distilling payer methodology and contract language, and zeroing in on proper documentation practices. With strong and compliant processes in place, you'll know how to track and trend denials. And when you understand their root cause, you can tailor your appeal to the denial at hand and take steps to change the errors that led to the denial. Your copy: Guides you through the denials management process Instructs you how to track and trend denials to identify their root cause Explains your role in denials management, reduction, and prevention Shows you how to comply with medical necessity standards and use best-practice information to manage level of care determinations The accompanying CD-ROM contains the forms, templates, and checklists found in the book, so you can download, adapt, and start using them right away. Who needs to read this book? Hospital case managers and directors of case management will find Prevent Denials and Win Appeals to be a valuable partner in compliance revenue integrity efforts. Your coworkers in the finance, health information management, and clinical documentation improvement areas will also find it to be an important tool.

This cutting-edge reference represents a new phase in the talkRA project-an initiative dedicated to improving the discipline of revenue assurance (RA) for communication providers. From blog to podcasts and now a book, the project offers a platform for a select group of RA experts to share ideas and best practices in revenue assurance, revenue manag

Drawing on her many years as a consultant to numerous companies big and small, author Rose Hightower infuses Internal Controls Policies and Procedures with her wealth of experience and knowledge. Instead of reinventing the wheel, your company can use this useful how-to manual to quickly and effectively put a successful program of internal controls in place. Complete with flowcharts and checklists, this essential desktop reference is a best practices model for establishing and enhancing your organization's control framework. These manuals are favorites for organizations and companies that need a foundation and grounding to ensure an internal control posture of integrity, credibility, method, process and process: or a reminder of its importance. URLs were included when first published to encourage the dissemination and distribution of relevant chapters to those interested and in charge of the specific departments. Although times have changed, the principles professed are sound and solid for today’s accounting and business environment. Implementing these cornerstones will produce a principled manageable approach. These manuals can be used by accounting individuals, finance departments, sole proprietor businesses, large corporations, accounting / auditing students and any others interested in specific topics or general disciplines. The discipline for the oversight processes and procedures are important when introducing or implementing auditing practices whether in accounting or throughout the organization. These manuals should be used together to provide the basics when setting up a department or specific process discipline, for learning about the strengths, weaknesses and opportunities within the specific focus areas.