Module B: Revenue Cycle Teams

CE Credits: 1.75

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This module looks at the key players involved in helping to achieve an efficient, healthy revenue cycle. It begins by looking at what constitutes a healthy team—one in which the members work in a positive environment so that they can feel physically, mentally and emotionally prepared to do their jobs well. Next, the module explores how CMs affect operating revenues through careful use of such tools as discharge plans. Finally, the module details how the claims and reimbursement process affects revenue, and how a CM’s knowledge of the often-complicated process benefits both the patient and the hospital.

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Learning objectives: After completing this module case managers will be able to:
» Discuss care team well-being as a prerequisite for an effective revenue cycle
» Review effective and participatory leadership
» Discuss the influence of case management on operating revenue
» Describe revenue cycle teams
» Discuss the building blocks of claims and reimbursement
» Review the terminology associated with claims and reimbursement

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Advance your professional practice: The processes by which care is authorized and reimbursed is complicated, and CMs can play a vital role for both patient and the healthcare team by being fluent in the entire process.

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Improve organizational performance: Because a hospital’s ongoing health is contingent upon solid reimbursement and efficient use of resources, it is important that all team members appreciate the complexities of the process— as well as the positive role that a CM can play in streamlining that process.