Click on any Chapter Title to download, view, or print individual chapters and appendices.

Chapter 1 Overview of Accounts Management

• 1.1 About the Revenue Operations Manual
• 1.2 About Account Reconciliation
• 1.3 About Explanation of Benefits and Remittance Advice Adjustments
• 1.4 Remittance Advice/Notice Rejection Codes
• 1.5 Explanation of Benefit/Remittance Advice Data Elements
• 1.6 Automated Posting
• 1.7 Medicare Health Care Claim Adjustment Reason Codes
• 1.8 Claim Processing Timeliness
• 1.9 Check Management Process
• 1.10 Financial Management Internal Controls
• 1.11 Monitoring Internal Controls

Chapter 2 Electronic Deposits and Remittance Advices

• 2.1 About Electronic Transactions
• 2.2 Electronic Reimbursement Process

Chapter 3 Processing Zero Pays

• 3.1 Preparing Zero Pays
• 3.2 Sorting Payments and Zero Pays with No Identifying Information
• 3.3 Processing Zero Pay Documents
• 3.4 Creating Batches for Zero Payment

Chapter 4 Creating Payment Batches

• 4.1 Procedure for Creating a Payment Batch
• 4.2 Editing Batches before Finalizing
• 4.3 Processing the Batches for Posting
• 4.4 Logging New Batches in the RA Log
• 4.5 Logging Posted Batches in the RA Log

Chapter 5 Processing Payments and Adjustments

• 5.1 Posting Payments and Adjustments
• 5.2 Posting Payments to Patient Accounts
• 5.3 Posting Medicare/Railroad Retirement Released Payments
• 5.4 Posting an Adjustment
• 5.5 Posting an Interest Payment/Adjustment
• 5.6 Posting Payment Recoupments

Chapter 6 Reconciliation of Credit/Negative Balances

• 6.1 Procedure for Reconciliation of Credit/Negative Balances
• 6.2 Processing Payments Received and Batched in Error
• 6.3 Medicare Provider Credit Balance Reporting
• 6.4 Adjustment Request Form

Chapter 7 Collections

• 7.1 Overview of Collections
• 7.2 Legal Aspects of Collection
• 7.3 Financial Responsibility
• 7.4 Collection Process
• 7.5 Collecting Insurance Reimbursements
• 7.6 Transworld Systems Debt Collection

Chapter 8 Collection Strategies

• 8.1 Overview of Collection Strategies
• 8.2 Negotiation Guidelines
• 8.3 The Art of Listening
• 8.4 Payment Motivators
• 8.5 Five Ways to Change a Patient's Mind
• 8.6 Collection Calls

Chapter 9 Rejections and Appeals

• 9.1 Medicaid Appeal Process
• 9.2 Private Insurance Appeal Process
• 9.3 Collection Policies and Procedures for Submitted Claims
• 9.4 Verifying Eligibility
• 9.5 Medicare Appeals Process
• 9.6 The Revised Medicare Appeals Process
• 9.7 Medicare Part B Appeals Process - Carriers
• 9.8 Medicare Part B Appeals Process
• 9.9 General Guidelines for Writing Appeals
• 9.10 Quality Control
• 9.11 Additional Resources

Appendixes

1. PNC Lockbox Collections Report
2. RA Log Samples
3. Medicare Appeals Process Comparison