The below objectives were taken from a survey conducted to multiple healthcare practitioners and we need the content to be framed for a general healthcare audience and not for a single organization.

1- Target Audience (Public):

• Revenue Cycle / Billing Officers
•  Finance & Accounting staff in healthcare
•  Insurance & Claims Officers
•  Clinic / Hospital Operations Managers
•  Medical Directors & Practice Owners (non-finance background)
• Dentists on coding or RCM positions

2- Duration :

- 1-day (6–7 hours) OR

- 2 half-days and the final decision is based on field expert advice (Trainer)

3. Learning Objectives (include but not limited) and could have more objectives based on trainer advice as well.

By the end of the course, participants will be able to:

1. Understand the end-to-end healthcare revenue cycle

2. Identify leakage points that cause revenue loss

3. Apply best practices in coding, billing, and claims management

4. Reduce denials and rejections

5. Align RCM operations with payer requirements and compliance

6. Improve cash flow and financial sustainability

4. Core Course Structure 

Module 1: Introduction to Revenue Cycle Management- What is RCM in healthcare?

• Why RCM fails in many healthcare organizations
•  RCM vs traditional finance
• Key stakeholders in the revenue cycle

Module 2: Patient Access & Front-End Revenue Control

•  Patient registration & demographics accuracy
•  Eligibility & insurance verification
•  Pre-authorization & referral management
•  Price transparency & financial counseling
• Common front-end errors that impact claims

Module 3: Clinical Documentation & Medical Coding

• Clinical documentation integrity
•  ICD-10, CPT, HCPCS overview (non-technical)
• Physician documentation vs coder dependency
•  Common coding errors impacting reimbursement
•  Compliance & audit risks

Module 4: Charge Capture & Billing

•  Charge capture workflow
•  Charge lag and revenue leakage
• Hospital vs clinic billing differences
•  Timely billing standards
• Clean claim principles

Module 5: Claims Submission & Payer Management

• Claims lifecycle
• Electronic vs manual submission
• Payer rules & variations
• National vs private insurance considerations
•  Contractual terms & reimbursement models

Module 6: Denials & Rejections Management

• Denials vs rejections (critical distinction)
• Top denial reasons in healthcare
•  Root cause analysis
•  Appeals process
• KPI benchmarks for denial rates

Module 7: Accounts Receivable (AR) & Cash Collection

•  AR aging analysis
•  Follow-up strategies
•  Write-offs vs adjustments
• Bad debt vs charity care
•  Improving Days in AR

Module 8: Compliance, Audit & Risk Management

•  Regulatory compliance in RCM
•  Internal audits
• Fraud, abuse & billing risks
•  Documentation & traceability
• Legal exposure due to RCM failures

Module 9: RCM KPIs & Performance Management

• Core RCM KPIs:
• Days in AR
• First-pass claim rate
• Denial rate
• Collection rate
• Net revenue realization
• Dashboard examples
• How leadership should read RCM reports
• Module 10: Future of RCM & Digital Transformation
• Automation & AI in RCM
• HIS / ERP integration
• Outsourcing vs in-house RCM
•  Centralized vs decentralized models
•  Skills required for future RCM professionals

5. Interactive Elements to Agree On

• Case study: Why a claim was rejected
• Mini exercise: identify leakage points
• Group discussion
• Simple KPI interpretation activity
•