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Medical Coding RCM Presentation

The document provides an introduction to medical coding and revenue cycle management (RCM), detailing their definitions, importance, and the roles of key stakeholders. It outlines the steps in the RCM cycle, including patient registration, insurance verification, charge capture, claim submission, and denial management. Additionally, it highlights the significance of compliance in medical coding and RCM, along with potential career opportunities in the field.

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shankarnri66
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6 views16 pages

Medical Coding RCM Presentation

The document provides an introduction to medical coding and revenue cycle management (RCM), detailing their definitions, importance, and the roles of key stakeholders. It outlines the steps in the RCM cycle, including patient registration, insurance verification, charge capture, claim submission, and denial management. Additionally, it highlights the significance of compliance in medical coding and RCM, along with potential career opportunities in the field.

Uploaded by

shankarnri66
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Introduction to Medical Coding &

Revenue Cycle Management (RCM)


• Presented by Tricode Training Academy
• Your Name & Contact Information
Introduction to Medical Coding
• • Definition of Medical Coding
• • Importance in healthcare
• • Role of medical coders
Basics of Medical Coding
• • ICD (International Classification of Diseases)
• • CPT (Current Procedural Terminology)
• • HCPCS (Healthcare Common Procedure
Coding System)
• • Real-world examples
What is Revenue Cycle
Management (RCM)?
• • Definition of RCM
• • Importance in healthcare
• • Key stakeholders (Patients, Providers, Payers,
Coders, Billers)
Steps in the RCM Cycle
• 1. Patient Registration
• 2. Insurance Eligibility & Verification
• 3. Charge Capture & Medical Coding
• 4. Claim Submission
• 5. Claim Processing by Payer
• 6. Payment Posting & Reconciliation
• 7. Denial Management
• 8. Accounts Receivable & Collections
Step 1 - Patient Registration
• • Collecting patient demographics
• • Insurance details verification
• • Importance of accuracy in registration
Step 2 - Insurance Eligibility &
Verification
• • Verifying insurance coverage
• • Pre-authorization requirements
• • Common challenges and solutions
Step 3 - Charge Capture & Medical
Coding
• • Translating clinical services into codes
• • Ensuring accurate documentation
• • Importance of compliance with coding
guidelines
Step 4 - Claim Submission
• • Preparing and submitting claims
• • Role of clearinghouses
• • Common errors that cause claim rejection
Step 5 - Claim Processing by Payer
• • Payer reviews the claim
• • Approval, denial, or request for additional
information
• • How insurance companies determine
payments
Step 6 - Payment Posting &
Reconciliation
• • Understanding Explanation of Benefits (EOB)
• • Posting payments correctly
• • Identifying underpayments or incorrect
payments
Step 7 - Denial Management
• • Common reasons for denials
• • How to appeal denied claims
• • Strategies for reducing claim denials
Step 8 - Accounts Receivable &
Collections
• • Managing outstanding balances
• • Following up with insurance and patients
• • Best practices in collections
Importance of Compliance in
Medical Coding & RCM
• • HIPAA regulations
• • Fraud prevention
• • Audits and quality assurance
Career Opportunities in Medical
Coding & RCM
• • Medical coder
• • Billing specialist
• • Compliance auditor
• • RCM analyst
Conclusion & Q&A
• • Summary of key points
• • Open for questions
• • Contact information

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