Part 1 - Administrative Roles and Responsibilities
Click on any Chapter Title to download, view, or print individual chapters and appendices.
Chapter 1 Overview of Revenue Operations
- 1.1 About the Revenue Operations Manual
- 1.2 About the Indian Health Service
- 1.3 The Role of the Business Office in the IHS Mission
- 1.4 Headquarters Role and Responsibilities
- 1.5 Area Office Responsibilities
- 1.6 Reporting
- 1.7 Revenue Generation Areas
- 1.8 Utilization of Operational Materials
Back to top
Chapter 2 Laws, Acts, and Regulations Affecting Health Care
- 2.1 Privacy Act (1974)
- 2.2 Health Insurance Portability and Accountability Act (1996)
- 2.3 Privacy Rule
- 2.4 Patient Self-Determination Act
- 2.5 False Claims Act
- 2.6 Emergency Medical Treatment and Active Labor Act (EMTALA)
- 2.7 Balanced Budget Act (1997)
- 2.8 Federal Medical Care Recovery Act (FMCRA)
- 2.9 Administrative Simplification Compliance Act
- 2.10 Indian Health Care Improvement Act Reauthorization (2001)
- 2.11 Access to Medical Treatment Act (2001)
- 2.12 Medically Underserved Access to Care Act (2001)
- 2.13 Drug Availability and Health Care Access Improvement Act (2001)
- 2.14 Health Care Antitrust Improvements Acts (2002)
Back to top
Chapter 3 IHS Laws, Regulations, and Policies
- 3.1 Overview of IHS Laws, Regulations, and Policies
- 3.2 IHS Legislative Program Authority
- 3.3 Billing and Collection Authority
- 3.4 Statutory Bases of Liability-Fraud and Abuse
Back to top
Chapter 4 Health Insurance Portability and Accountability Act Privacy Rule
- 4.1 About the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule
- 4.2 HIPAA Training
- 4.3 Impact of Privacy Regulations on the Business Office
- 4.4 Protected Health Information (PHI) Use and Disposal
- 4.5 Maintaining Patient Confidentiality
- 4.6 HIPAA and Pharmacy Compliance
Back to top
Chapter 5 Business Office Management
- 5.1 Overview of Business Office Management
- 5.2 Third-Party Revenue Accounts Management and Internal Controls Policy
- 5.3 Corporate Compliance Program
- 5.4 RPMS Reports
- 5.5 Outsourcing Billing Office Functions
- 5.6 Secure Patient Information
- 5.7 File Management
- 5.8 Consent/Signature Forms
- 5.9 Insurer Provider Numbers
Back to top
Chapter 6 Business Office Staff
- 6.1 Business Office Staff Descriptions
- 6.2 Performance Appraisal and Productivity
- 6.3 Examples of Performance Evaluation Criteria
Back to top
Chapter 7 Business Office Quality Process Improvement
- 7.1 Accreditation and Patient Rights, Confidentiality, Privacy, and Safety Requirements
- 7.2 Quality Performance and Improvement
- 7.3 Flow Charts for Process Improvement
- 7.4 Registration Performance Tracking
- 7.5 Benefit Coordinator Performance Tracking
- 7.6 Billing Performance Tracking
- 7.7 Monitoring Productivity
- 7.8 Training and Business Process Improvement
- 7.9 Pay-for-Performance Demonstrations
- 7.10 Quality Improvement Organization
Back to top
Chapter 8 Compliance
- 8.1 About the Corporate Compliance Program
- 8.2 Implementing Written Policies and Procedures
- 8.3 Designating a Compliance Officer and Committee
- 8.4 Conducting Effective Training and Education
- 8.5 Developing Effective Lines of Communication
- 8.6 Enforcing Standards through Well-Publicized Disciplinary Guidelines
- 8.7 Conducting Internal Monitoring and Auditing Activities
- 8.8 Responding to Detected Offenses and Developing Corrective Actions
- 8.9 Evaluating and Monitoring Compliance-Related Risks
Back to top
Appendices
- A. Business Office Workflow Diagrams
Back to top
|