Revenue Cycle: Professional Services

Description

Since coding is such an important part of the reimbursement cycle, it makes sense that you know the basics of the revenue cycle as it relates to billing for professional services. This course will explore billing for professional services, different types of payers, RVU concept, importance of medical necessity and an introduction to LCDs and NCDs.

Objectives:

Lesson 1: Introduction to Professional Fee Coding and Revenue Cycle

• Differentiate between professional fee coding and facility coding
• Identify the claim form that is generally used for billing profession fee services
• Define common medical billing terms

Lesson 2: Insurance Basics

• Define common terms used when talking about health insurance
• Compare different types of healthcare insurance plans
• Differentiate between Medicare and Medicaid

Lesson 3: Payer Mix and the RBRVS

• Describe the Resource-based Relative Value Scale and examine how it applies to payment
• Select information available on the Medicare Physician Fee Schedule

Lesson 4: Medical Necessity and Coverage Determinations

• Discover what a Medicare Administrative Contractor (MAC) is and which regions they cover
• Differentiate between a local and national coverage determination