Chapter Title / The Five Phases of the Revenue Cycle / Date / 02-27-2014
Point of Contact / John Simon / eMail / / Phone / 571-483-1042
Topic Title / Welcome / Storyboard No. / 01-001
Onscreen Treatment / [[image LessonStart.jpg right, top]]
Course Purpose
The purpose of this module is to recognize the five phases of the revenue cycle, identify the responsibilities of all staff during the revenue cycle, and to reduce errors, especially in the input of personal and insurance information, by intake staff.
The terminal learning objective for this module is, given a patient presenting for care in a VA health care setting, identify the responsibilities of VHA revenue staff and the impact of the intake staff’s actions on positive revenue capture.
The content of an Executive Decision Memorandum (EDM) identified patterns of errors created by intake staff. These errors result in a loss of $70 million of revenue nationally for every .5 percent of errors. This eLearning course will be centered on these intake errors. There is quantifiable information as to the specific errors being made by personnel (e.g., insurance information entered incorrectly).
Completion of this course will increase your knowledge of the VA revenue process for Veterans Health Administration (VHA) staff and Consolidated Patient Account Center (CPAC) staff.
Previous Page / NA / Next Page / 01-002
Prompt / Select Next to continue.
Images / Image No. / Description or filename / Alternate Text/Long Description
1 / lessonStart.jpg / Arrowhead hitting target labeled Start
Programming Instructions
Topic Title / Course Information / Storyboard No. / 01-002
Onscreen Treatment / Target Audience
This course is designed for Veterans Health Administration (VHA) Employees (Intake Clerk/Coordinator, Eligibility and Intake Clerk, Eligibility and Enrollment Clerk, Program Support Assistant, or Medical Support Assistant) and their supervisors who conduct the initial interview or in processing of a Veteran/patient as they present for care at a US Department of Veterans Affairs (VA) Health Care Facility. The Certified Intake Processor is considered the “front line” for the Veterans Health Administration (VHA) and as such, much of the initial contact with the Veteran is provided by the Intake Clerks.
Course Length and Knowledge Check
You will need about half an hour to complete this course. In order to complete the course successfully, you are required to answer the knowledge check questions that appear at the end and achieve a score of 80 percent or higher. Subsequent courses will then be available to you.
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Programming Instructions
Topic Title / Course Objectives / Storyboard No. / 01-003
Onscreen Treatment / This course discusses the five phases of the Revenue Cycle and related staff responsibilities. This course will focus on the Intake Phase.
Upon completion of this course, you will be able to:
- Recognize the five phases of the Revenue Cycle.
- Identify the responsibilities of all staff during the Revenue Cycle.
- Differentiate between the functions of the Intake Phase.
- Identify the responsibilities of intake staff.
- Recognize the impact of your actions on the Intake Phase.
We are sure you’ll find this course helpful and that you’ll be able to use the information you receive in your day-to-day job.
Ready? OK, select Next to continue.
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Prompt / Select Next to continue.
Images / Image No. / Description or filename / Alternate Text/Long Description
1 / icon_revenue.png / Icon with graphic of dollar signs and supporting text “Revenue Fact”
Programming Instructions
Topic Title / The Revenue Cycle / Storyboard No. / 01-004
Onscreen Treatment /
[[Image all_phases.jpg - center, top]]
Being a Certified Intake Processor (CIP) is not just about going through the motions. The CIP needs to ask the right questions of the patient in order to solicit a verifiable answer. It requires good interpersonal skills and knowledge of intake processes. Let’s look at the entire VA Revenue Cycle and see how the Intake Phase fits in.
The Revenue Cycle is the process by which VA collects payments from third party health insurance companies in exchange for providing non-service connected (NSC) medical care.
TheRevenue Cycle is divided into five phases:
- Intake
- Utilization Review
- Billing
- Collections
- Appeals
When patientscovered by billable health insurance receive NSC care, revenue increases; but only if VA staff correctly execute the five phases of the Revenue Cycle.
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / all_phases.jpg / Five boxes representing the five phases of the Revenue Cycle arranged horizontally. The first box contains the supporting text: “Intake”and “Phase 1”; the second box contains the supporting text: “Utilization Review” and “Phase 2”; the third box contains the supporting text: “Billing” and “Phase 3”; the fourth box contains the supporting text: “Collections” and “Phase 4”; and the fifth box contains the supporting text: “Appeals” and “Phase 5”.
2 / icon_revenue.png / Icon with graphic of dollar signs and supporting text “Revenue Fact”
Programming Instructions
Topic Title / Intake Phase / Storyboard No. / 01-005
Onscreen Treatment / [[Image intake_phase.jpg - center, top]]
The first phase of the Revenue Cycle, the Intake Phase, is the point of entry into VA’shealthcare system allowing Veterans and eligible beneficiaries to gain access to medical care and schedule appointments. During the intake process, demographic and insurance information unique to the patient is entered into the Veterans Health Information Systems and Technology Architecture (VistA) and the insurance file,either manually or using the Insurance Capture Buffer (ICB).It is essential that this patient demographic and insurance information be collected and processed accuratelyduring theinitial steps of the intake process. The consequences ofincompleteor inaccurate information have widespread implications on revenue collection during the remaining phases of the Revenue Cycle, as well as a negative impact on the support and care of our patients.
[[Image icon_veteran.png- center, top]]
Examples of consequences to the Veteran may be:
- Veteran may not be placed in the correct priority group.
- Veteran is inappropriately identified as copay required.
- Veteran may not receive pertinent medical information or resources critical to their care.
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / intake_phase.jpg / Five boxes representing the five phases of the Revenue Cycle arranged horizontally. The first box is emphasized and is much larger than the other four and contains the supporting text: “Intake” and “Phase 1”. The remaining four boxes are smaller. The second box contains the supporting text: “Utilization Review” and “Phase 2”; the third box contains the supporting text: “Billing” and “Phase 3”; the fourth box contains the supporting text: “Collections” and “Phase 4”; and the fifth box contains the supporting text: “Appeals” and “Phase 5”.
2 / Icon_veteran.png / Selectable icon with graphic representing military dog tags with supporting text: “Impact on Veteran”
Programming Instructions
Topic Title / Utilization Review Phase / Storyboard No. / 01-006
Onscreen Treatment /
[[Imageutil_phase.jpg - center, top]]
The second phase of the Revenue Cycle is the Utilization Review (UR). CPAC Revenue Utilization Review (RUR) staff perform the UR process ensuring the care is appropriately authorized for third-party payment. Facility utilization management staffs are responsible for the UR process for TRICARE and non-VA medical care (NVC). The RUR nurses also coordinate with Consolidated Patient Account Center (CPAC) facility revenue staff so VA can accurately bill in a timely manner for episodes of care.
RUR nurses support the UR process by obtaining pre-authorizations for care, performing continued stay reviews for inpatient care to ensure additional days of care are approved for reimbursement under their insurance/benefit plan. Communications regarding reimbursement for care are documented in the VistA claims tracking menu.
In cases where claims are denied or appealed, RUR nurses are instrumental in working with the third-party payment to resolve disputes to ensure VA is paid appropriately.
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / util_phase.jpg / Five boxes representing the five phases of the Revenue Cycle arranged horizontally. The second box is emphasized and is much larger than the other four and contains the supporting text: “Utilization Review” and “Phase 2”. The remaining four boxes are smaller. The first box contains the supporting text: “Intake” and “Phase 1”; the third box contains the supporting text: “Billing” and “Phase 3”; the fourth box contains the supporting text: “Collections” and “Phase 4”; and the fifth box contains the supporting text: “Appeals” and “Phase 5”.
Programming Instructions
Topic Title / Billing Phase / Storyboard No. / 01-007
Onscreen Treatment /
[[Imagebilling_phase.jpg - center, top]]
The Billing Phaseoccurs upon completion and successful closure of outpatient encounters and inpatient stays. Facility staff identify patient care information and ensure all billable episodes of care are communicated to CPAC billing staff. However, billing done at the medical facility, rather than at CPAC, primarily consists of TRICARE andCivilian Health and Medical Program Veterans Administration(CHAMPVA) care.
CPAC billingstaffare responsible for generating claims to the Third-Party Payer (TPP) for NSCcare received by Veterans.This includes care provided by VA at the Community Based Outpatient Clinics (CBOCs) and in the community using thenon-VA medical care (NVC)program.
During this phase of the process, CPAC facility revenue and CPAC billingstaff perform the following duties:
- Identify billable events.
- Send reports to Health Information Management (HIM) to ensure accurate coding.
- Review the Bill Me Report daily.
- Create the third-party bill in VistA.
- Transmit the bill using the electronic data interchange (EDI).
- Submit the bill via EDI to the applicable TPP.
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / billing_phase.jpg / Five boxes representing the five phases of the Revenue Cycle arranged horizontally. The third box is emphasized and is much larger than the other four and contains the supporting text: “Billing” and “Phase 3”. The remaining four boxes are smaller. The first box contains the supporting text: “Intake” and “Phase 1”; the second box contains the supporting text: “Utilization Review” and “Phase 2”; the fourth box contains the supporting text: “Collections” and “Phase 4”; and the fifth box contains the supporting text: “Appeals” and “Phase 5”.
Programming Instructions
Topic Title / Collections Phase / Storyboard No. / 01-008
Onscreen Treatment / [[Imagecollect_phase.jpg - center, top]]
In the Collections Phase,CPAC Accounts Receivable (AR) technicians check the claim status and process receipt of payments from third-party payers (TPP).
Based on Chief Business Office (CBO) guidance, CPAC ARtechnicians check the claims statusfrequently in order to identify possible delays in collections. Additionally, CPAC AR technicianscheck claim status when an explanation of benefits (EOB)oran electronic remittance advice (ERA) is received.
After receiving an EOB or ERA, it is critical that the AR technician conducts adetailed review to ensure that the insurance plan benefits have been appropriatelyremitted to VA.
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / collect_phase.jpg / Five boxes representing the five phases of the Revenue Cycle arranged horizontally. The fourth box is emphasized and is much larger than the other four and contains the supporting text: “Collections”and “Phase 4”. The remaining four boxes are smaller. The first box contains the supporting text: “Intake”and “Phase 1”; the second box contains the supporting text: “Utilization Review”and “Phase 2”; the third box contains the supporting text: “Billing”and “Phase 3”; and the fifth box contains the supporting text: “Appeals” and “Phase 5”.
Programming Instructions
Topic Title / Appeals Phase / Storyboard No. / 01-009
Onscreen Treatment / [[Imageappeal_phase.jpg - center, top]]
The Appeals Phase is instituted when a discrepancy in billing or collections needs to be resolved.
Upon finding that the insurance payment was incorrectly paidor denied, the CPAC AR technician contacts the TPP. If the discrepancy cannot be resolved by the CPAC AR technician, an appeal is initiated.
Appeal support may be received from multiple personnel and departments within the VA medical facility and within the aligned CPAC.
VA entities such as CPAC RUR, CPAC Payer Relations, or Office of Regional Counsel may then be contacted to support the resolution of escalated disputed payments.
Previous Page / 01-008 / Next Page / 01-010
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / appeal_phase.jpg / Five boxes representing the five phases of the Revenue Cycle arranged horizontally. The fifth box is emphasized and is much larger than the other four and contains the supporting text: “Appeals” and “Phase 5”. The remaining four boxes are smaller. The first box contains the supporting text: “Intake” and “Phase 1”; the second box contains the supporting text: “Utilization Review” and “Phase 2”; the third box contains the supporting text: “Billing” and “Phase 3”; and the fourth box contains the supporting text: “Collections and “Phase 4”.
Programming Instructions
Topic Title / The Intake Process / Storyboard No. / 01-010
Onscreen Treatment /
[[Imageintake_phase.jpg - center, top]]
Now, let’s focus on the Intake Phase.
When performingpatient intake, your primary responsibilities as intake staff are:
- Patient Registration (focus on demographic and Veteran eligibility information).
- Insurance identification for TPP reimbursement (Note:Insurance information is validated by CPAC insurance verification (IV) staff.)
- TRICARE and CHAMPVAbenefit eligibility (Note:VA medical facility staff are responsible for performing IVfunctions.)
Previous Page / 01-009 / Next Page / 01-011
Prompt / Select Next to continue.
Images / Image No. / Description or filename / Alternate Text/Long Description
1 / intake_phase.jpg / Five boxes representing the five phases of the Revenue Cycle arranged horizontally. The first box is emphasized and is much larger than the other four and contains the supporting text: “Intake”. The remaining four boxes are smaller. The second box contains the supporting text: “Utilization Review”; the third box contains the supporting text: “Billing”; the fourth box contains the supporting text: “Collections”; and the fifth box contains the supporting text: “Appeals”.
Programming Instructions
Topic Title / Patient Registration / Storyboard No. / 01-011
Onscreen Treatment / [[Imagevet.jpg - right, top]]
Patient Registration encompasses activities relating to the initial establishment of an individual's application for VA health services, determination of their eligibility for these benefits, and enrollment in VA’s health care system.
The VA uses data collected during the registration process to identify the types of health services requested, uniquely establish the patient’s record, and assess the applicant's priority for enrollment in VA healthcare.
Identifying the correct eligibility determines the patient’s copay status and if they will be responsible for costs incurredfor health care, long-term careand outpatient prescriptions.
[[Image icon_veteran.png–left, bottom]]
Veteran eligibility for mileage reimbursement is based on priority group determination.
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Prompt / Select Next to continue.
Images / Image No. / Description or filename / Alternate Text/Long Description
1 / vet.jpg / A vet stands at a counter and presents himself for treatment at a VA facility
2 / Icon_veteran.png / Selectable icon with graphic representing military dog tags with supporting text: “Impact on Veteran”
Programming Instructions
Topic Title / Insurance Identification for TPP / Storyboard No. / 01-012
Onscreen Treatment / [[Imagehealth_insurance.jpg - right, top]]
Insurance identification is the process for determining the existence of a TPP responsible for covering a portion of the cost of providing medical care to the patient.
Identification of insurance may occur at the time of enrollment, before the visit/admission,during pre-registration, or at the point of service.
Once insurance information is identified, the insurance card with policyholder information is either:
1)Scanned using the ICB scanner and software; or
2)Entered manually into the ICB work list for IV; or
3)A copy of the card is sent to the assigned IV point of contact via outlook (encrypted email), regular interoffice mail, or US mail (if an ICB scanner or ICB software is unavailable).
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / health_insurance.jpg / Several pages of a document with the title: “Health Insurance” printed on the first page
Programming Instructions
Topic Title / Insurance Verification / Storyboard No. / 01-013
Onscreen Treatment / [[Imageinsurance_form.jpg - right, top]]
Insurance verification (IV) provides validation that the identified insurance is active for purposes of billing NSC care to TPPs.
- CPAC IV staff are responsible for verifying all TPPs with the exception of TRICARE and CHAMPVA.
- The VA medical facility staff is responsible for identifyingand verifying TRICARE and CHAMPVA benefit eligibilityduring the intake process.
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / insurance_form.jpg / An insurance claim form, with a pair of reading glasses sitting on top of it
Programming Instructions
Topic Title / I CARE: Customer Service / Storyboard No. / 01-014
Onscreen Treatment / [[Imageicare_logo.jpg - right, top]]
Customer service is a proactive attitude that can be summed up as: “I care and I can do.”
In addition to your primary responsibilities of patient registration and insurance identification, your overarching priority is to provide great customer service to the patient when they visit a VA medical facility.
Select each element of the I CARE acronym for a more detailed explanation.
[[TOGGLE]]
- Integrity
- Commitment
- Advocacy
- Respect
- Excellence
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Images / Image No. / Description or filename / Alternate Text/Long Description
1 / Icare_logo.jpg / ICARE logo with supporting text: “I CARE, Department of Veterans Affairs”
Programming Instructions / When each item in the list is selected, show the info on the next page. Each toggle item must be selected before the Next button becomes active.
Integrity / Act with high moral principle. Adhere to the highest professional standards. Maintain the trust and INTEGRITY confidence of all with whom I engage.
Commitment / Work diligently to serve Veterans and other beneficiaries. Be driven by an earnest belief in VA’s mission. Fulfill my individual responsibilities and organizational responsibilities.
Advocacy / Be truly Veteran‐centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries.
Respect / Treat all those I serve and with whom I work with dignity and respect. Show respect to earn it.
Excellence / Strive for the highest quality and continuous improvement. Be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them.
Topic Title / The Patients and Their Stories / Storyboard No. / 01-015
Onscreen Treatment /
[[Image VA_line.jpg - left, top]]
[[content area – right, top]]
Intake staff are under continuous pressure to collect information, not only quickly, but also accurately. Often, the staff member is the first to interact with the Veteran or beneficiary.Patient experience with the local VA medical facility may be varied.Intake staff should be aware that the patient may not know what information to present, may not understand the benefits of supplying the information, or are unaware that changes (address, insurance, employment, etc.) need to be communicated. The challenge facing each intake staff member is to collect the data quickly and accurately while providing the patient a dignified and professional experience.
Each patient has a story. Some situations present challenges to the intake process such as:
1)Failure to bring proper documentation or proper identification.
2)Significant changes in personal data that needs to be updated in the patient record.
Select each of the numbered people to see how each patient’s circumstance could result in an inaccurate patient record and contribute to a loss of revenue for VA.
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Prompt / Select Next to continue.
Images / Image No. / Description or filename / Alternate Text/Long Description
1 / VA_line.jpg / A diverse group of men and women representing patients standing in line and extending across the page. Four of the patients have selectable icons numbered “one” through “four.”
Programming Instructions / When each number is selected show the information on the next page. Each toggle item must be selected before the Next button becomes active.
Patient One: This patient shares that he has moved to a new house very recently and the information in VistA is not current.