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Introduction

The IR-DRG course is a guide to understand the classification and dimensions of diagnostic homogenous groups, principles, components, assignment logic, calculation of the DRG’s

It also shows how the DRG’s impacts the patient Quality of care in standardizing medical data and accurately capturing the patient severity of illness, risk of mortality, resource weight, average length of stays, optimal maximal reimbursements for the hospitals and severity drivers along with case studies

The course will also make you understand how Clinical documentation improvement impacts the DRG’s and the case mix index (CMI) for the individual hospital

Course Objectives

  • Learn how to determine DRG weight
  • Eliminate reimbursement loopholes by accurate application of DRG
  • Get familiar with the various components of DRG and apply them in calculation
  • Understand the implication of CDI in determining right DRGs

Learning Outcomes

By the end of this course, you should be able to:
  • Know what are the Diagnostic Related Group, and understand the dimensions of IR- DRG classifications
  • Explain the definition of principal and secondary diagnosis in the context of coding guidelines
  • Recognize the Case Mix Index (CMI) and how it is impacted by the Clinical Documentation Improvement (CDI)
  • Manage the patient severity levels for the level of care provided in the context of clinical documentation and successfully know and apply the procedure hierarchy (CDI)
  • Learn from the examples of IR-DRG and CDI impact on severity of illness, risk of mortality, length of stay, resource weight and reimbursements


For the detailed Course Agenda, Download the brochure.



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Introduction

Certificate In Healthcare Revenue Cycle Management (CHRCM) is an online course to help you understand the basics of healthcare RCM. It navigates the learner from “What is RCM to Healthcare RCM, global trends and best practice to regional insights and the scope of CDI (Clinical Documentation Improvement) in RCM.

Introduction to CHRCM provides a complete overview of different departments or units of RCM and the RCM process flow from patient registration to end billing. This modular course covers RCM learning from an international perspective and is not confined to any one country standards. We have included various roles of RCM in our course; that serve as a source of knowledge and also helps you identify a suitable RCM model for improved revenues and financial outcomes.

This course will benefit

Healthcare professionals keen to understand the Revenue Cycle Management; including but not limited to:
  • Physicians
  • Nurses, allied health professionals
  • Administrative and billing professionals
  • Managers, team leaders, supervisors and heads from insurance and coding departments
  • Senior executives who are keen to gain a macro-overview and understanding of RCM function

Course Objectives

By the end of the entire course; you will be able to:
  • Comprehend different versions of codes available in any RCM practice and recognize the differences in various versions of coding in respect to the country’s Healthcare Billing System
  • Gain 360 degrees understanding of RCM concepts and principles ranging from coding to insurance protocols to billing regulations and compliance; in addition to claim submissions, insurance denials, and reconciliations
  • Become aware of Revenue Cycle Management (RCM) concepts to maximize the billing potential leading to increased revenues and improved financial results


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Introduction

Knwbility’ s Denial Management for Specialties course offers a complete understanding of the rejection analysis, claims status checks, resolution of the denied claims, resubmission process. The core objective is to help collect all payments that are due for the medical billing services that have been delivered.

Terms such as claim denial and claim rejections are often used interchangeably by the healthcare billing personnel as both may be considered part of the denial management processes. Rejected claims will not be processed as they have not been received/accepted by the payor, therefore, these claims do not make it into the adjudication system. This simply means that a rejected claim must be submitted when the errors have been corrected. Occasionally; this leads to the reduction in cash-flows.

This course helps the learner identify and understand the difference between denials and rejections.

This course will benefit

  • Billing associates
  • RCM administrators, Managers
  • Medical Auditors, CDI Specialists
  • Physicians and other allied health personnel
  • Coders

Learning Objectives


Module 1 Denial Management - Introductory Module
By the end of this module; you will be able to:
  • Identify when to raise a physician query before encountering a denial
  • Recognize methods of compliance to support the denial management process
  • Become aware of the insurance/ payer guidelines to avoid denials
  • Reduce the claims rejection encounters by the facilities
  • Discover ways to improve the coding and billing process leading to improved Revenue Cycle Management (RCM)
Module 2 Denial Management - Specialty
By the end of this module; you will be able to:
  • Interpret clinical scenarios to accurately assign codes to specialty cases
  • Recognize the opportunities to identify and correct the issues that cause the claims to be denied by the insurance company
  • Classify denials by reason, source, cause and other distinguishing factors
  • Develop and assess effective denial management strategies
  • Accurately apply ICD-10-CM / CPT guidelines and other applicable diagnosis/procedures codes to outpatient case scenarios
  • Validate the accuracy of the physician-assigned codes and check if all the guidelines were applied in the code selection process to avoid the denials
  • Analyse and practice denial case studies

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