Optimizing Financial Performance, Billing, and Compliance in Healthcare Revenue Management

Introduction

Revenue Cycle Management (RCM) is the backbone of financial sustainability in hospitals, clinics, and healthcare providers. Efficient RCM ensures that healthcare organizations maximize reimbursements, streamline billing processes, reduce claim denials, and comply with regulatory requirements.

This 5-day intensive course is designed for healthcare finance professionals, administrators, medical billers, and revenue cycle managers who want to enhance their understanding of RCM workflows, revenue optimization, and compliance strategies. Participants will gain hands-on experience in claims processing, patient billing, and insurance reimbursements, while learning how to reduce revenue leakage and improve cash flow.

Course Objectives

By the end of this course, participants will be able to:

• Understand the full revenue cycle from patient registration to final payment.
• Optimize medical billing, coding accuracy, and claims management.
• Improve denial management and accounts receivable performance.
• Navigate Medicare, Medicaid, and private insurance reimbursement rules.
• Implement RCM technology, AI-driven automation, and best practices.
• Ensure regulatory compliance with HIPAA, CMS guidelines, and healthcare fraud prevention.

Who Should Attend?

This course is ideal for professionals involved in healthcare finance, medical billing, and revenue optimization, including:

• Revenue cycle managers and healthcare administrators.
• Medical billing and coding professionals.
• Healthcare finance and reimbursement specialists.
• Hospital CFOs and financial analysts.
• Compliance officers and healthcare auditors.

Course Outline

Day 1: Introduction to Healthcare Revenue Cycle Management (RCM)

• Overview of the revenue cycle: Patient scheduling to final payment.
• Key financial metrics in healthcare RCM: Net collection rate, AR days, denial rate.
• Understanding payer reimbursement models (FFS, VBC, bundled payments).
• Common revenue cycle challenges and how to solve them.
• Regulatory compliance: HIPAA, CMS, and insurance fraud prevention.

Workshop: Mapping the revenue cycle workflow for a healthcare provider.

Day 2: Medical Billing, Coding, and Claims Management

• ICD-10, CPT, and HCPCS coding essentials for accurate claims submission.
• Medical necessity and documentation requirements.
• Preventing coding errors and reducing claim denials.
• Understanding Explanation of Benefits (EOB) and Remittance Advice (RA).
• Handling rejected and denied claims effectively.

Case Study: Identifying errors in medical billing claims and fixing them.

Day 3: Denial Management and Insurance Reimbursement Strategies

• Top reasons for claim denials and how to avoid them.
• Denial tracking, analysis, and appeals process.
• Insurance contract negotiation and reimbursement optimization.
• Improving cash flow through AR management.
• Medicare, Medicaid, and private payer reimbursement guidelines.

Scenario Analysis: Developing a denial management strategy for a hospital.

Day 4: RCM Technology, AI, and Automation

• AI and machine learning in revenue cycle automation.
• Electronic Health Records (EHR) and Revenue Cycle Integration.
• Telemedicine billing and reimbursement challenges.
• Revenue leakage detection and prevention strategies.
• RCM outsourcing vs. in-house revenue management.

Workshop: Evaluating AI-driven solutions for automating revenue cycle workflows.

Day 5: Financial Performance, Compliance, and Future Trends in RCM

• Monitoring KPIs and improving revenue cycle efficiency.
• Auditing RCM processes for regulatory compliance.
• Value-Based Care (VBC) and alternative payment models.
• Emerging trends in healthcare revenue management.
• Final Capstone: Participants develop a revenue cycle improvement plan for a healthcare facility.

Conclusion & Certification

Participants who complete the course and pass the final assessment will receive a Certification in Healthcare Revenue Cycle Management, demonstrating expertise in RCM strategies, compliance, and financial optimization in healthcare.

Program Benefits

• Expert-Led Training – Learn from healthcare finance and RCM professionals.
• Hands-On Learning – Work on real-world medical billing and revenue scenarios.
• Financial & Compliance Focus – Covers reimbursement rules, claim audits, and fraud prevention.
• Strategic Revenue Optimization – Strengthen denial management and AR performance.
• Career Advancement – Gain an edge in healthcare finance, administration, and RCM leadership.

Career Opportunities After Certification

• Revenue Cycle Manager – Overseeing billing, collections, and reimbursement strategies.
• Medical Billing & Coding Specialist – Ensuring accurate claims processing and payment recovery.
• Healthcare Finance Consultant – Advising hospitals and clinics on revenue cycle improvements.
• Healthcare Compliance Auditor – Monitoring billing accuracy and fraud prevention.
• Hospital CFO or Financial Analyst – Managing RCM strategies and financial health of healthcare organizations.