A. There are six steps in the revenue cycle: provider services, document services,

establish charges, prepare claim/bill, submit claim, and receive payment. First step is provider

services, this is when the services for the patient are provided. The medical record is formed

while the services are being performed, as information is being collected from different

departments and areas throughout the facility.

Second, document services, here is where all information that has been gathered becomes

critical. In 1996, HIPAA proposed the requirement of two coding methods to be used for all

payors. These coding methods are referred to as ICD-10-CM CPT/HCPCS codes. ICD-10-CM is

diagnosis coding where CPT/HCPCS is procedure coding. Both are required for the professional

and facility side. This varies based on if it is an inpatient or outpatient event or whether diagnosis

or procedure all affects the final reimbursement.

Third, establishing charges, this is where the charge master (CDM) comes into play. For

every service there is a unique cost. The CDM take key information that is required for the claim

as well as the patient medical record and determines charges that will be placed on the claim.

Vital information needed in the CDM include a number unique to a specific charge, revenue cost,

dollar value for the service, assigned department number, and the HCPCS/CPT code (If

applicable).

Fourth, preparing the claim/bill. This step is where all charges found during a patients

encounter generate to the claim. There are usually two types of claims, CMD-1500 and CMS-

1450 (UB04). CMS-1500 is typical use for physician practices and suppliers. CMS-1450 is used

for various institution types. Previously claims were sent to the insurance carriers manually, but