Week 1

Management Trainee Process

Contents
Introduction
Medical billing
DME and HME
RCM and the processes involved
A successful case study
An unsuccessful case study
Conclusion
Introduction and Overview
Who are we

What do we do
What are we good at
Medical Billing
Medical billing is gthe process of getting a provider
paid for their services rendered to the policy holder
from the insurance company for the claimed amount
or from the policy holder for the uncovered amount
DME and HME
Durable Medical Equipment are those that are rated to
withstand a prolonged usage by non-professionals or
the patient and is appropriate for use at home. Home
Medical Equipment are those which are used to take
care of the patients outside the healthcare facility or in
their homes.
PROCHANT

Revenue Cycle Management and

Medical Billing
 Revenue cycle management (RCM) is the financial process,
utilising medical billing software, that healthcare facilities
use to track patient care episodes from registration and
appointment scheduling to the final payment of a balance.
Communicating with health insurance companies is a key
component of RCM
PROCHANT

Revenue Drivers
PROCHANT
 RCM
1.

Scenario: 1

Patient-James Johnson
Age – 68
Insured-Primary, Secondary
Hospitalization - April  24-april 30
Diagnosis- ICD-10-CM Z98.84
SNF-100 Days
MARK OPTED FOR THE
FOLLOWING:
Conclusion
In short, we saw about ourselves, what we do, then we
saw waht RCM is along with it’s processes explained by
Rahul which was followed by Indhuja who narrated a
successful claim case and Prasanna who gave us an
idea of an unsuccessful claim case which also covered
the concepts and terminology which we learnt
throughout this week.