Medical insurance a revenue cycle process approach pdf

The seventh edition of Medical Insurance: An Integrated Claims Process Approach emphasizes the medical billing cycle-ten steps that clearly identify all the components needed to successfully manage the medical insurance claims process. The cycle shows how administrative medical professionals "follow the money." Medical insurance specialists must be familiar with the rules and guidelines of each health plan in order to submit proper documentation, which then ensures that offices receive maximum, appropriate reimbursement for services provided. Learn the skills you need for your health professions career using multiple digital resources. The claims case studies can be completed via CMS-1500 form activities or by using simulated Medisoft exercises, both available in Connect, McGraw-Hill Education's homework and assessment platform. Read and study the content more effectively-spending more time on topics you don't know and less time on the topics you do-by using LearnSmart and SmartBook, McGraw-Hill's revolutionary adaptive learning technology.

About the Author

Nenna L. Bayes , AAS, BBA, M.Ed., CPC, has coauthored
and reviewed various titles within the medical administrative fields. She earned an
associate of applied business degree, a bachelor of business administration degree,
and a masters of arts in education from Morehead State University. During her tenure,
she has taught numerous courses within the administrative and medical administrative
curriculum. She is a professor in and the program coordinator for the Office
Systems Technology and Medical Information Technology programs at Ashland
Community and Technology College in Ashland, Kentucky, and has received many
teaching excellence awards. She is also a certified professional coder (CPC). Prior to
teaching, she worked in various medical office environments. Additionally, she is a
member of the American Academy of Professional Coders (AAPC) and the American
Health Information Management Association (AHIMA).
She lives in Flatwoods, Kentucky, with her husband and is blessed to have two
children and two granddaughters . She is actively involved in music and enjoys
camping in her leisure time.

Cynthia Newby, CPC, CPC-P, is a long-serving author who works closely with McGraw-Hill Education instructional development staff to develop excellent MIBC programs. Cynthia is a graduate of Hood College and a trustee of that institution as well as her local animal shelter and library.

Amy L. Blochowiak, MBA, RHIT, ACS, AIAA, AIRC, ARA,FLHC, FLMI, HCSA, HIA, HIPAA, MHP, PCS, SILA-F, has coauthored and reviewed various textbooks within the medical administrative and insurance fields. She earned associate degrees in medical office mid-management and health information technology from Northeast Wisconsin Technical College, bachelor’s degrees in both business administration and marketing from Lakeland College, and a master’s degree in business administration from Lakeland College. She is currently the program director and instructor for the Healthcare Business Professional program at Northeast Wisconsin Technical College, where she sits on many committees and shares her passion for student success. Prior to teaching, she worked in various insurance industry roles for over 16 years. She is a member of the American Health Information Management Association (AHIMA).

What are the steps in the medical billing revenue cycle?

Revenue cycle starts with the appointment or hospital visit and ends when the provider or hospital gets paid fully for the services provided. The seven steps of revenue cycle include preregistration, registration, charge capture, claim submission, remittance processing, insurance follow-up and patient collections.

What is revenue cycle in medical?

The Healthcare Revenue Cycle is defined by the Healthcare Financial Management Association as the set of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.

What are the 10 steps in the medical billing revenue cycle?

10 Steps of Revenue Cycle Management.
Patient Registration and Insurance Eligibility. ... .
Encounter. ... .
Charge Capture and Medical Coding. ... .
Claim Scrubbing and Submission. ... .
Claim Status Inquiry. ... .
Remittance Advice. ... .
Denials and Appeals. ... .
Payment Posting..

What is revenue cycle management PDF?

The revenue cycle and revenue cycle management (RCM) are the terms used to describe the process by which healthcare systems track revenue coming into their practice, from both patients and health insurance companies (often called 'payers' or 'payors').