Revenue Operations Manual (ROM)

Part 1 - Administrative Roles and Responsibilities

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

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)

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

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

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

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

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

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

Appendices

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