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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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(HIPAA) Medicare Part D Revenue Operations Manual (ROM) Third Party Internal Controls Patient Registration Third Party Billing National Business Office Coordinator’s Meeting Minutes Accounts Receivable Management Tools Unified Financial Management System (UFMS) Business Office Solutions Training ListServ Questions or Comments. Please contact the Site Manager

Revenue Operations Manual (ROM)

Part 5 - Accounts Management

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

Chapter 1. Overview of Accounts Management [PDF-116KB]

  • 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
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Chapter 2. Electronic Deposits and Remittance Advices [PDF-30KB]

  • 2.1 About Electronic Transactions
  • 2.2 Electronic Reimbursement Process
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Chapter 3. Processing Zero Pays [PDF-48KB]

  • 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
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Chapter 4. Creating Payment Batches [PDF-56KB]

  • 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
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Chapter 5. Processing Payments and Adjustments [PDF-75KB]

  • 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
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Chapter 6. Reconciliation of Credit/Negative Balances [PDF-58KB]

  • 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
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Chapter 7. Collections [PDF-106KB]

  • 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
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Chapter 8. Collection Strategies [PDF-73KB]

  • 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
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Chapter 9. Rejections and Appeals [PDF-174KB]

  • 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
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Appendixes

  1. PNC Lockbox Collections Report [PDF-283KB]
  2. RA Log Samples [PDF-20KB]
  3. Medicare Appeals Process Comparison [PDF-37KB]
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