Skilled Nursing Facility

Q&A: Preparing revenue cycle education for clinical staff

Q: What are some key revenue cycle topics that should be included in education geared toward clinical staff?

A: Education for clinical staff should be specifically tailored to their functions and their direct interaction with and impact on the revenue cycle. Clinical staff should not be inundated with information that is not relevant to them. The education should make the connection between clinical functions and revenue cycle operations clear. Consider the following as a general guideline for topics that should be covered in a clinical staff education program:

  • Documentation policies and best practices to ensure documentation is fully compliant with current laws and regulations
  • Documentation requirements as they relate to the following:
    • Establishing medical necessity
    • Clinical indicators and treatment to support the diagnoses and procedures for accurate coding, billing, and charge capture
  • Payer regulations (including commercial payer contract terms) and compliance obligations
  • Provider- and issue-specific education by monitoring queries and tracking documentation problems
  • Proper patient status assignment and preauthorization requirements

For more information, see the CHRI Exam Study Guide.