HIT235 Week 1 Study Guide | Revenue Cycle Management
HIT235
Week 1 Study Guide
Revenue Cycle Management, ROI, HIPAA, Compliance, and Health Care
Laws
Big picture for Week 1
This week connects patient care, medical coding, billing, insurance claims, compliance, and
reimbursement. Think of RCM as the path money and information travel from patient
registration to final payment, denial, appeal, or collection.
Quick Navigation
Course overview and objectives
Revenue cycle basics and the front/middle/back end
HIPAA, PHI, ePHI, Privacy Rule, Security Rule, and safeguards
Release of Information (ROI) and HIPAA identifiers
Fraud, abuse, health care laws, and compliance
Claims adjudication, remittance advice, EOBs, and denials
Technology, AI, RPA, predictive analytics, and emerging HIM careers
Quiz answer keys and end-of-chapter review answers
Created from Week 1
, HIT235 Week 1 Study Guide | Revenue Cycle Management
1. Course Overview
Course focus: HIT235 explores reimbursement and payment methods in health care while
reviewing forms, processes, and practices. Week 1 introduces insurance, third-party payment,
managed care organizations, data exchange, billing integrity, and medical coding connections.
Course Objectives by Module
Module Objective
1 Evaluate revenue cycle management and regulatory requirements in health care.
2 Analyze the key components of health care finance.
3 Analyze the charge description master (CDM) and components of the CMS-1450 and
CMS-1500 claim forms.
4 Differentiate between the Inpatient Prospective Payment System (IPPS) and Outpatient
Prospective Payment System (OPPS).
5 Apply the basic components of hospital performance and quality measures.
6 Apply the key principles of provider queries and clinical documentation improvement.
7 Use denials, appeals, and audits for compliance and improvement opportunities.
Week 1 focus
The major Week 1 objective is to understand RCM and how regulatory requirements, HIPAA,
ROI, and payer rules affect claims, reimbursement, and patient trust.
Created from Week 1
HIT235
Week 1 Study Guide
Revenue Cycle Management, ROI, HIPAA, Compliance, and Health Care
Laws
Big picture for Week 1
This week connects patient care, medical coding, billing, insurance claims, compliance, and
reimbursement. Think of RCM as the path money and information travel from patient
registration to final payment, denial, appeal, or collection.
Quick Navigation
Course overview and objectives
Revenue cycle basics and the front/middle/back end
HIPAA, PHI, ePHI, Privacy Rule, Security Rule, and safeguards
Release of Information (ROI) and HIPAA identifiers
Fraud, abuse, health care laws, and compliance
Claims adjudication, remittance advice, EOBs, and denials
Technology, AI, RPA, predictive analytics, and emerging HIM careers
Quiz answer keys and end-of-chapter review answers
Created from Week 1
, HIT235 Week 1 Study Guide | Revenue Cycle Management
1. Course Overview
Course focus: HIT235 explores reimbursement and payment methods in health care while
reviewing forms, processes, and practices. Week 1 introduces insurance, third-party payment,
managed care organizations, data exchange, billing integrity, and medical coding connections.
Course Objectives by Module
Module Objective
1 Evaluate revenue cycle management and regulatory requirements in health care.
2 Analyze the key components of health care finance.
3 Analyze the charge description master (CDM) and components of the CMS-1450 and
CMS-1500 claim forms.
4 Differentiate between the Inpatient Prospective Payment System (IPPS) and Outpatient
Prospective Payment System (OPPS).
5 Apply the basic components of hospital performance and quality measures.
6 Apply the key principles of provider queries and clinical documentation improvement.
7 Use denials, appeals, and audits for compliance and improvement opportunities.
Week 1 focus
The major Week 1 objective is to understand RCM and how regulatory requirements, HIPAA,
ROI, and payer rules affect claims, reimbursement, and patient trust.
Created from Week 1
