U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Business Office Enhancement
 
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Revenue Operations Manual (ROM)


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 [PDF-256KB]

  • 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
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Chapter 2. Laws, Acts, and Regulations Affecting Health Care [PDF-97KB]

  • 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)
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Chapter 3. IHS Laws, Regulations, and Policies [PDF-91KB]

  • 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
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Chapter 4. Health Insurance Portability and Accountability Act Privacy Rule [PDF-92KB]

  • 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
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Chapter 5. Business Office Management [PDF-156KB]

  • 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
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Chapter 6. Business Office Staff [PDF-123KB]

  • 6.1 Business Office Staff Descriptions
  • 6.2 Performance Appraisal and Productivity
  • 6.3 Examples of Performance Evaluation Criteria
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Chapter 7. Business Office Quality Process Improvement [PDF-128KB]

  • 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
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Chapter 8. Compliance [PDF-66KB]

  • 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
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Appendices

  1. Business Office Workflow Diagrams [PDF-316KB]
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