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

1. Overview of Revenue Operations [PDF-255KB]
2. Laws, Acts, and Regulations Affecting Health Care [PDF-97KB]
3. IHS Laws, Regulations, and Policies [PDF-91KB]
4. Health Insurance Portability and Accountability Act Privacy Rule [PDF-91KB]
5. Business Office Management [PDF-155KB]
6. Business Office Staff [PDF-122KB]
7. Business Office Quality Process Improvement [PDF-127KB]
8. Compliance [PDF-65KB]
A. Business Office Workflow Diagrams [PDF-315KB]

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Part 2: Patient Registration

1. Overview of Patient Registration [PDF-74KB]
2. Patient Eligibility, Rights & Grievances [PDF-72KB]
3. Direct Care and Contract Health Services [PDF-59KB]
4. Registration, Discharge, and Transfer [PDF-139KB]
5. Third Party Coverage [PDF-208KB]
6. Scheduling Appointments [PDF-33KB]
7. Benefit Coordinator [PDF-82KB]
A. Application for Medical Services (Form 58, Adult) [PDF-52KB]
B. Indian Blood Quantum Formula [PDF-17KB]
C. Name Change/Birth Date Correction Request [PDF-20KB]
D. Admission Call-In/Check-Off List [PDF-38KB]

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Part 3: Coding

1. Overview of Coding [PDF-53KB]
2. Medical Record Documentation [PDF-50KB]
3. Coding Guidelines [PDF-147KB]
4. Data Entry [PDF-37KB]

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Part 4: Billing

1. Overview of Billing [PDF-123KB]
2. Hard Copy Versus Electronic Claims Processing [PDF-41KB]
3. Billing Medicare [PDF-173KB]
4. Billing Medicaid [PDF-29KB]
5. Billing Private Insurance [PDF-67KB]
6. Third Party Liability Billing [PDF-25KB]
7. Billing Private Dental Insurance [PDF-42KB]
8. Billing Pharmacy [PDF-31KB]
9. Secondary Billing Process [PDF-29KB]
A. IHS Reimbursement Methods [PDF-35KB]
B. CMS 1400/UB-92 Form [PDF-391KB]

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Part 5: Accounts Management

1. Overview of Accounts Management [PDF-116KB]
2. Electronic Deposits and Remittance Advices [PDF-29KB]
3. Processing Zero Pays [PDF-47KB]
4. Creating Payment Batches [PDF-56KB]
5. Processing Payments and Adjustments [PDF-74KB]
6. Reconciliation of Credit/Negative Balances [PDF-58KB]
7. Collections [PDF-105KB]
8. Collection Strategies [PDF-73KB]
9. Rejections and Appeals [PDF-173KB]
A. PNC Lockbox Collections Report [PDF-282KB]
B. RA Log Samples [PDF-20KB]
C. Medicare Appeals Process Comparison [PDF-36KB]


ROM Acronyms [PDF-100KB]

ROM Glossary [PDF-184KB]

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