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Healthcare Operations & Administration
Healthcare Revenue Cycle and Claims Fundamentals
How a clinical encounter becomes a paid claim — and why it so often does not.
professional240 min6 lessons
What you'll learn
- Sequence the stages of the revenue cycle for a described encounter
- Identify the cause of a described claim rejection
- Classify a described denial and select an appropriate response
- Calculate and interpret a revenue cycle metric from given data
- Identify a charge capture failure in a described process
- Evaluate a pre-authorisation process for risk
Course content
6 modules · 6 lessons
1. The Cycle End to End
- The Cycle End to EndPreview40m
2. Front End: Eligibility and Authorisation
- Front End: Eligibility and Authorisation40m
3. Charge Capture and Coding
- Charge Capture and Coding40m
4. Submission, Edits and Remittance
- Submission, Edits and Remittance40m
5. Denials and Appeals
- Denials and Appeals40m
6. Measuring the Cycle
- Measuring the Cycle40m