Revenue Cycle Management for Hospitals Course

Training Outlines

Introduction

Hospital revenue depends on accurate, timely coordination across clinical, administrative and financial processes. This course develops an end-to-end view of the revenue cycle and practical methods for preventing leakage, accelerating payment and protecting patient and regulatory obligations.

Objectives

• Map the hospital revenue cycle and clarify functional accountabilities
• Strengthen registration, eligibility and financial-clearance controls
• Improve clinical documentation, charge capture and coding accuracy
• Evaluate claim preparation, submission and payment-posting processes
• Identify denial causes and implement prevention strategies
• Manage receivables, collections and patient financial communication
• Apply compliance, audit and revenue-integrity controls
• Use revenue-cycle indicators to prioritise sustainable improvement

Course Outlines

Day 1: Revenue Cycle Architecture and Patient Access

• End-to-end revenue-cycle process map
• Payer, patient and provider responsibilities
• Registration accuracy and identity controls
• Eligibility and benefit verification
• Prior authorisation and financial clearance
• Patient estimates and financial communication

Day 2: Documentation, Coding and Charge Integrity

• Clinical documentation requirements
• Charge capture across service areas
• Coding workflows and accuracy controls
• Medical necessity and supporting evidence
• Charge-master governance and maintenance
• Pre-bill edits and revenue leakage

Day 3: Claims, Payments and Denials

• Clean-claim preparation and submission
• Claim scrubbing and rejection management
• Payment posting and reconciliation
• Contractual adjustments and underpayments
• Denial classification and root causes
• Appeals, resubmissions and prevention

Day 4: Receivables, Compliance and Control

• Accounts-receivable ageing and prioritisation
• Payer follow-up and escalation
• Patient balances and ethical collections
• Fraud, waste and abuse risk controls
• Internal audits and revenue integrity
• Data privacy and record retention

Day 5: Analytics and Revenue Improvement

• Revenue-cycle KPI selection
• Days, denial and collection indicators
• Dashboard design and trend analysis
• Process variation and bottleneck analysis
• Improvement initiatives and accountability
• Benefits tracking and action planning