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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HIM/CHS/Partnership Conferences Health Insurance Portability and Accountability Act
(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 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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