Revenue Cycle Uncovered

Specialized Topics & Deep Dives · Revenue Integrity & Contract Management Fee Schedule Comparison Tool Compare user-entered reimbursement rates and explore how different payment scenarios affect estimated revenue. Includes a Fee Comparison sheet, Payer Contract Tracker, Rate Scenario calculator, and Read Me instructions. Example rates are illustrative, not verified contracted rates. Open Excel workbook in Google Drive Excel workbook (.xlsx). Open the link and use File → Download to save a copy. Sample data is fictional. Avoid entering patient-identifying information into shared copies. Revenue Cycle Uncovered is an independent educational resource. Content is provided for general informational purposes and does not represent the policies, practices, or positions of any employer or organization. Workflows, payer requirements, regulations, and operational practices may vary. Information should be independently verified when applied to specific situations. Explore Reven...

Specialized Topics & Deep Dives · Revenue Integrity & Contract Management Claims Payment Variance Worksheet Compare expected and actual claim-line payments, and identify differences for further review. The workbook has a Payment Variance worksheet, a Summary tab, and Read Me guidance. It calculates expected insurance payment and signed paid, allowed, and patient-responsibility variances from entered values. Open Excel workbook in Google Drive Excel workbook (.xlsx). Open the link and use File → Download to save a copy. Sample data is fictional. Avoid entering patient-identifying information into shared copies. Revenue Cycle Uncovered is an independent educational resource. Content is provided for general informational purposes and does not represent the policies, practices, or positions of any employer or organization. Workflows, payer requirements, regulations, and operational practices may vary. Information should be independently verified when applied to specific s...

Specialized Topics & Deep Dives · Denials & AR Billing & AR Follow-Up Log Track claim follow-up work, open balances, payer activity, and the next action for each account. The workbook contains a Follow-Up Log, a live Summary Dashboard, and Quick Start instructions. It includes fictional sample entries, calculated balances, and highlighted overdue follow-up dates. Open Excel workbook in Google Drive Excel workbook (.xlsx). Open the link and use File → Download to save a copy. Sample data is fictional. Avoid entering patient-identifying information into shared copies. Revenue Cycle Uncovered is an independent educational resource. Content is provided for general informational purposes and does not represent the policies, practices, or positions of any employer or organization. Workflows, payer requirements, regulations, and operational practices may vary. Information should be independently verified when applied to specific situations. Explore Revenue Cycle Uncover...

Get & Transform Data in Excel For the reports that arrive every week needing exactly the same cleanup. You download an accounts receivable report, remove a few unnecessary columns, fix the date formatting, and organize the information into something useful. Then next week arrives, and you do it all over again. Excel Power Query can help with that. Power Query is a data preparation feature that lets you import, clean, reshape, and combine information through repeatable steps. Instead of manually performing the same changes every time, you can create a query and refresh it when new data becomes available. It's particularly handy for recurring AR reports, denial inventories, payment exports, and other spreadsheets that need consistent preparation. Give It a Try In a supported version of Excel, open the Data tab and choose Get Data or From Table/Range , depending on where your information is stored. Once the Power Query Editor opens, try removing an unnecessary colu...

SNOMED CT Browser A searchable resource for exploring clinical concepts, terminology, and the relationships between medical terms. Clinical terminology doesn't always fit neatly into one familiar description. A condition may have multiple accepted names, related terms, or more specific variations. The SNOMED CT Browser , provided by SNOMED International, lets users explore standardized clinical concepts and see how they relate to one another. Each concept has a unique identifier and associated descriptions. The browser also displays hierarchical relationships, making it useful when you're trying to understand unfamiliar terminology or distinguish closely related clinical concepts. How to Explore It Visit the SNOMED CT Browser and select an available terminology edition and version. Search using a clinical term or an existing SNOMED CT concept identifier. Open a result to review its descriptions, preferred wording, and relationships to broader or more specific conce...

The Red Edits That Stop a Claim Before It Starts What happens when a billing system identifies an error before a claim request can be created? Green. Blue. Red. In NextGen Enterprise Practice Management, these colors can communicate very different outcomes when claim requests are being produced. According to NextGen's Claim Production Status documentation, green indicates that a pending claim request was successfully created. Blue identifies a configured warning that still allowed a pending claim request to be created. Red means the affected item did not produce a claim request because an error requires correction. For a billing specialist working through encounters awaiting billing, that distinction matters. A red message may explain why an encounter hasn't moved into the next stage of the revenue cycle, even though no clearinghouse rejection or payer denial exists. What the Red Message Represents NextGen's claim-editing functionality evaluates encounter inform...

The Self-Pay Discount That Didn't Add Up An Alameda Health System audit uncovered two unexpected financial adjustments and a verification workflow that allowed electronic consultations to advance before essential checks were completed. During a 2024 internal audit, Alameda Health System identified two self-pay discounts that had been applied because insurance information was missing, even though that information was available in the original consultation requests. The finding emerged during a review of the organization's electronic consultation process. These consultations, commonly called e-consults, allow providers to obtain clinical input from another provider electronically. As auditors examined how the requests moved through the system, they found that patient verification wasn't consistently completed before orders were accepted. The discounts were part of broader findings involving insurance verification and financial adjustments. Although the audit doesn...

Creative Corner | Puzzle Collection | Easy Easy Word Searches A relaxed starting point featuring familiar revenue cycle terminology. Find revenue cycle terms hidden in the grids. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Easy Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Puzzle Collection | Easy Easy Word Scrambles A relaxed starting point featuring familiar revenue cycle terminology. Unscramble revenue cycle vocabulary using the provided clues. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Easy Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Puzzle Collection | Easy Easy Crosswords A relaxed starting point featuring familiar revenue cycle terminology. Solve revenue cycle clues and fill in the crossword grid. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Easy Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Puzzle Collection | Moderate Moderate Word Searches A little more of a challenge, with terminology from everyday workflows and account resolution. Find revenue cycle terms hidden in the grids. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Moderate Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Puzzle Collection | Moderate Moderate Word Scrambles A little more of a challenge, with terminology from everyday workflows and account resolution. Unscramble revenue cycle vocabulary using the provided clues. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Moderate Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Puzzle Collection | Moderate Moderate Crosswords A little more of a challenge, with terminology from everyday workflows and account resolution. Solve revenue cycle clues and fill in the crossword grid. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Moderate Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Puzzle Collection | Challenging Challenging Word Searches For readers ready to work through more specialized terminology and complex revenue cycle concepts. Find revenue cycle terms hidden in the grids. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Challenging Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Puzzle Collection | Challenging Challenging Word Scrambles For readers ready to work through more specialized terminology and complex revenue cycle concepts. Unscramble revenue cycle vocabulary using the provided clues. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Challenging Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Puzzle Collection | Challenging Challenging Crosswords For readers ready to work through more specialized terminology and complex revenue cycle concepts. Solve revenue cycle clues and fill in the crossword grid. Choose a Puzzle Open the collection folder to choose from three printable puzzles and their matching answer keys. Browse Puzzles & Answer Keys → 3 puzzles + 3 answer keys | Printable PDFs | Challenging Printing: Open the folder, select a puzzle PDF, and download it. Print at actual size (100%) on US Letter paper. Answer keys are provided as separate files, so you can print only what you need. ← Return to Creative Corner

Creative Corner | Coloring Collection This May Take a While Still loading. Please remain patient. Ready to Color? Download the printable PDF and bring your own colored pencils. Download Printable PDF ↓ PDF | US Letter (8.5 × 11 in.) | Black & White | 1 Page Printing: Open the PDF in Google Drive and select Download. For best results, print on US Letter paper at actual size (100%). Avoid enlarging the page beyond the printer's available margins. ← Return to Creative Corner

Creative Corner | Coloring Collection Accounts Receivable Graveyard Aged to the graveyard. Follow-up RIP. Ready to Color? Download the printable PDF and bring your own colored pencils. Download Printable PDF ↓ PDF | US Letter (8.5 × 11 in.) | Black & White | 1 Page Printing: Open the PDF in Google Drive and select Download. For best results, print on US Letter paper at actual size (100%). Avoid enlarging the page beyond the printer's available margins. ← Return to Creative Corner

Creative Corner | Coloring Collection QC Mountain: In Progress The queue keeps growing. The checklist gets longer. At least the view from the top should be nice. Ready to Color? Download the printable PDF and bring your own colored pencils. Download Printable PDF ↓ PDF | US Letter (8.5 × 11 in.) | Black & White | 1 Page Printing: Open the PDF in Google Drive and select Download. For best results, print on US Letter paper at actual size (100%). Avoid enlarging the page beyond the printer's available margins. ← Return to Creative Corner

Creative Corner | Coloring Collection You Are Not Your Queue The worklist will still be there tomorrow. A gentle reminder from somewhere underneath the pending accounts. Ready to Color? Download the printable PDF and bring your own colored pencils. Download Printable PDF ↓ PDF | US Letter (8.5 × 11 in.) | Black & White | 1 Page Printing: Open the PDF in Google Drive and select Download. For best results, print on US Letter paper at actual size (100%). Avoid enlarging the page beyond the printer's available margins. ← Return to Creative Corner