STUVIA 2024/2025
CMAA Module 6
A series of administrative functions that are required to capture and collect payment for
services provided by a health care organization. - ✔✔Revenue Cycle
sent out on a regular basis, and outstanding balances need to be monitored. Any
nonpayment from the patient requires collection activities. - ✔✔Patient statements
should be
Registering and scheduling - ✔✔Revenue cycle begins
they have received the final payment for services - ✔✔Revenue Cycle ends
Collecting precise demographic information, accurate data-entry, verifying accurate
coding, and timely billing all impact the patient experience. Complete and accurate
claims promote a healthy revenue cycle and build patient trust and confidence in the
organization. - ✔✔The patient experience can be affected throughout a patient's
%
health care journey, including the revenue cycle. What are some of the actions that
impact the patient experience related to billing?
practice management system (PMS) to perform revenue cycle tasks and streamline
front office and back office workflows with automation - ✔✔Today, most health care
organizations use a
to boost productivity and can help with sustainability and stronger financial
performance. Scheduling appointments, charge capture, coding, billing, generating
financial/aging reports, generating patient statements, and managing the accounts
receivable are all examples of how the PMS is efficiently used. - ✔✔The practice
management system is an efficient way
An efficient way to electronically manage administrative functions, such as scheduling
appointments, integrating patient documentation from electronic health records, coding,
stuvia
, STUVIA 2024/2025
billing, and revenue cycle tasks such as running aging reports and managing the
accounts receivable. - ✔✔Practice Management System PMS
This step occurs when the patient calls for an appointment. The CMAA will gather
patient information such as demographic and insurance information, determine the
type of appointment needed, and enter the appointment on the provider's schedule.
During appointment scheduling, the patient may be asked to arrive 15 min early to
complete new patient registration forms or update existing information. - ✔✔Phases of
Revenue Cycle Registration and Scheduling
The patient completes the registration (demographic and insurance), HIPAA, and other
compliance and policy forms, along with medical history information. The CMAA will
scan or copy the patient's insurance card and cross-check the information completed
on the registration form to the data entered in the practice management system (PMS)
during the registration and scheduling step, then changes the patient's status to
checked in. - ✔✔Phases of Revenue Cycle PT Check in
%
Also known as utilization review (UR), this is the process of ensuring the patient has
the appropriate referral, precertification, predetermination, or preauthorization as
needed. This process supports the revenue cycle by ensuring the payer, provider, and
patient have met any required conditions and understand how the service will be
reimbursed and what the patient responsibility amount will be. Not all services or
procedures will require a UR. The CMAA must be familiar with rules and guidelines for
third-party payers, as they will vary.
When in doubt, always verify by contacting the payer to determine if UR is necessary
for the procedure or service. Documentation of UR is important for scheduling and
claims purposes. For example, once a preauthorization is obtained, document the
authorization number, expiration date, and any specified details in the patient's health
record.
Prior to the procedure or service being p - ✔✔Phases of Revenue Cycle Utilitzation
Management Review
Finding out if the service is covered by the patient's plan. - ✔✔precertification
stuvia
, STUVIA 2024/2025
Determining the payer's reimbursement amount for the service. - ✔✔predetermination
Finding out if the payer considers a service medically necessary based on the patient's
specific condition. - ✔✔preauthorization
The health care encounter and documentation are part of the clinical aspect of the
revenue cycle. The provider will review the patient's medical history and reason for the
encounter, perform a physical exam as indicated, order any diagnostic or lab tests, and
perform an assessment and develop a treatment plan. The CMAA would verify
coverage for certain procedures, obtain the preauthorization, and document it in the
PMS or medical record. - ✔✔Phases of Revenue Cycle Health Care Encounter and
Documentation
Once the encounter and documentation are complete, charge capture or charge entry
is performed. This is the process of capturing each procedure code and corresponding
diagnosis code for the encounter in preparation for billing. Depending on organizational
policy, the provider may select the codes (CPT®, HCPCS, and ICD-10-CM) for the
%
encounter, and the CMAA may verify the codes for completeness and import or enter
them into the billing application. It is important to ensure that the diagnosis code(s)
supports the medical necessity of the procedural codes. - ✔✔Phases of Revenue
Cycle Charge Capture and Coding
When the encounter with the provider has ended, the patient wil proceed to check-out.
If a return appointment needs to be scheduled, ask the patient what day/time works
best for their schedule. Collect the copay if it was not collected during the check-in
process and any coinsurance or deductible amounts that may have incurred during the
encounter and have been verified with the insurance company. Some organizations
use real-time adjudication to support this task.
The patient will be presented with an after-visit summary (AVS), which includes
demographic information on file, the reason for the encounter, vital signs, tests/labs
ordered, the conditions managed at the time of the encounter, and related patient
instructions or educational materials. Most importantly, the patient should feel they
received top-quality care from check-in to check-out. The CMAA should thank the
stuvia
CMAA Module 6
A series of administrative functions that are required to capture and collect payment for
services provided by a health care organization. - ✔✔Revenue Cycle
sent out on a regular basis, and outstanding balances need to be monitored. Any
nonpayment from the patient requires collection activities. - ✔✔Patient statements
should be
Registering and scheduling - ✔✔Revenue cycle begins
they have received the final payment for services - ✔✔Revenue Cycle ends
Collecting precise demographic information, accurate data-entry, verifying accurate
coding, and timely billing all impact the patient experience. Complete and accurate
claims promote a healthy revenue cycle and build patient trust and confidence in the
organization. - ✔✔The patient experience can be affected throughout a patient's
%
health care journey, including the revenue cycle. What are some of the actions that
impact the patient experience related to billing?
practice management system (PMS) to perform revenue cycle tasks and streamline
front office and back office workflows with automation - ✔✔Today, most health care
organizations use a
to boost productivity and can help with sustainability and stronger financial
performance. Scheduling appointments, charge capture, coding, billing, generating
financial/aging reports, generating patient statements, and managing the accounts
receivable are all examples of how the PMS is efficiently used. - ✔✔The practice
management system is an efficient way
An efficient way to electronically manage administrative functions, such as scheduling
appointments, integrating patient documentation from electronic health records, coding,
stuvia
, STUVIA 2024/2025
billing, and revenue cycle tasks such as running aging reports and managing the
accounts receivable. - ✔✔Practice Management System PMS
This step occurs when the patient calls for an appointment. The CMAA will gather
patient information such as demographic and insurance information, determine the
type of appointment needed, and enter the appointment on the provider's schedule.
During appointment scheduling, the patient may be asked to arrive 15 min early to
complete new patient registration forms or update existing information. - ✔✔Phases of
Revenue Cycle Registration and Scheduling
The patient completes the registration (demographic and insurance), HIPAA, and other
compliance and policy forms, along with medical history information. The CMAA will
scan or copy the patient's insurance card and cross-check the information completed
on the registration form to the data entered in the practice management system (PMS)
during the registration and scheduling step, then changes the patient's status to
checked in. - ✔✔Phases of Revenue Cycle PT Check in
%
Also known as utilization review (UR), this is the process of ensuring the patient has
the appropriate referral, precertification, predetermination, or preauthorization as
needed. This process supports the revenue cycle by ensuring the payer, provider, and
patient have met any required conditions and understand how the service will be
reimbursed and what the patient responsibility amount will be. Not all services or
procedures will require a UR. The CMAA must be familiar with rules and guidelines for
third-party payers, as they will vary.
When in doubt, always verify by contacting the payer to determine if UR is necessary
for the procedure or service. Documentation of UR is important for scheduling and
claims purposes. For example, once a preauthorization is obtained, document the
authorization number, expiration date, and any specified details in the patient's health
record.
Prior to the procedure or service being p - ✔✔Phases of Revenue Cycle Utilitzation
Management Review
Finding out if the service is covered by the patient's plan. - ✔✔precertification
stuvia
, STUVIA 2024/2025
Determining the payer's reimbursement amount for the service. - ✔✔predetermination
Finding out if the payer considers a service medically necessary based on the patient's
specific condition. - ✔✔preauthorization
The health care encounter and documentation are part of the clinical aspect of the
revenue cycle. The provider will review the patient's medical history and reason for the
encounter, perform a physical exam as indicated, order any diagnostic or lab tests, and
perform an assessment and develop a treatment plan. The CMAA would verify
coverage for certain procedures, obtain the preauthorization, and document it in the
PMS or medical record. - ✔✔Phases of Revenue Cycle Health Care Encounter and
Documentation
Once the encounter and documentation are complete, charge capture or charge entry
is performed. This is the process of capturing each procedure code and corresponding
diagnosis code for the encounter in preparation for billing. Depending on organizational
policy, the provider may select the codes (CPT®, HCPCS, and ICD-10-CM) for the
%
encounter, and the CMAA may verify the codes for completeness and import or enter
them into the billing application. It is important to ensure that the diagnosis code(s)
supports the medical necessity of the procedural codes. - ✔✔Phases of Revenue
Cycle Charge Capture and Coding
When the encounter with the provider has ended, the patient wil proceed to check-out.
If a return appointment needs to be scheduled, ask the patient what day/time works
best for their schedule. Collect the copay if it was not collected during the check-in
process and any coinsurance or deductible amounts that may have incurred during the
encounter and have been verified with the insurance company. Some organizations
use real-time adjudication to support this task.
The patient will be presented with an after-visit summary (AVS), which includes
demographic information on file, the reason for the encounter, vital signs, tests/labs
ordered, the conditions managed at the time of the encounter, and related patient
instructions or educational materials. Most importantly, the patient should feel they
received top-quality care from check-in to check-out. The CMAA should thank the
stuvia
