Course Provider
Learning Objectives
Articulate the revenue cycle for hospital payment models. They will have a deeper understanding of coverage for Medicare for Outpatient vs Inpatient coverage and patient liability for both. Participants will be able to articulate coverage for Medicare A, B, C, & D
Analyze how their task/role impacts the revenue cycle; denials and overall revenue integrity outcomes in the hospital setting; reimbursement related to fee for service and billed charges; and the difference between government and commercial payors
Identify hospital regulatory guidelines related to Utilization Management. This includes but not limited to notification requirements for patient type changes in benefit coverage; Utilization Management Requirements related to conditions of participation; and the function and requirements of hospital UM committee