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 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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