Map the revenue cycle from patient registration through coding, charge capture and claim submission.
Healthcare & Pharmaceutical Management
Denials Management and Revenue Integrity in Medical Billing
Prepares revenue cycle and coding teams to trace denial root causes, protect charge integrity and build a revenue integrity function that reduces avoidable revenue loss.
🗓️Duration5 training days
📚Content4 modules · 8 sessions
🎓On completionAccredited attendance certificate
About the programme
Course Overview
Healthcare organisations routinely write off preventable revenue because denied claims are worked one at a time by billing staff rather than traced back to the registration, documentation or coding step that caused them, so the same denial reason recurs month after month. This course maps the revenue cycle from registration and eligibility verification through coding, charge capture and claim submission, then applies a denial taxonomy and root-cause analysis to separate technical, clinical and coding denials. It covers auditing clinical documentation and charge capture for accuracy, maintaining the charge description master, and building front-end controls, including eligibility checks and claim-scrubbing edits, that prevent denials before submission. Later modules address preparing appeals and peer-to-peer reviews, and building a revenue integrity function that brings coding, documentation and compliance under shared performance metrics. Teaching uses denial taxonomies, audit checklists and appeal templates drawn from hospital and physician billing operations. Participants leave able to cut avoidable denials and to report revenue integrity performance with confidence.
Expected Learning Outcomes
Classify denials into technical, clinical and coding categories using a standard denial taxonomy.
Audit clinical documentation and coding accuracy against payer and regulatory guidance.
Reconcile charge capture systems against clinical documentation to close revenue leakage.
Configure front-end eligibility and claim-scrubbing controls that prevent avoidable denials.
Prepare first-level appeals and peer-to-peer reviews with the evidence each denial reason requires.
Build a revenue integrity function that reports denial and collection performance on shared metrics.
Who Should Attend
Revenue cycle directors responsible for denial rates and days in accounts receivable.
Medical coding and clinical documentation improvement specialists.
Patient access and eligibility verification team leaders.
Compliance officers overseeing coding and billing regulatory risk.
Physician practice managers responsible for claims and collections performance.
Revenue integrity analysts building denial and charge capture dashboards.
Course Modules
Select any module to see its sessions and points.
01Revenue Cycle and the Origins of Denials
2 sessions · 8 points
Session 1Mapping the Revenue Cycle
- Trace the patient journey from registration and eligibility verification through claim submission.
- Identify where prior authorisation and medical necessity checks sit within the revenue cycle.
- Map coding and charge capture steps that translate clinical documentation into a billable claim.
- Locate the control points where front-end errors most often create downstream denials.
Session 2Denial Taxonomy and Root-Cause Analysis
- Classify denials into technical, clinical and coding categories using a standard denial taxonomy.
- Apply Pareto analysis to prioritise the denial reasons with the greatest revenue impact.
- Distinguish front-end causes, such as eligibility errors, from coding or documentation causes.
- Trace recurring denial patterns back to specific process steps or departments.
02Coding, Documentation and Charge Integrity
2 sessions · 8 points
Session 1Clinical Documentation and Coding Accuracy
- Audit clinical documentation for the specificity that accurate procedure and diagnosis coding requires.
- Run coding compliance audits against payer and regulatory coding guidance.
- Implement clinical documentation improvement queries that close gaps before claim submission.
- Track coding accuracy and query response rates as leading indicators of denial risk.
Session 2Charge Capture and Charge Description Master Integrity
- Reconcile charge capture systems against clinical documentation to identify missed or duplicate charges.
- Maintain the charge description master, including code updates and pricing accuracy.
- Run periodic charge capture audits across high-risk departments such as surgery and imaging.
- Correct systemic charge errors at their source rather than through repeated manual rework.
03Managing and Appealing Denials
2 sessions · 8 points
Session 1Denial Prevention and Front-End Controls
- Deploy eligibility verification and authorisation checks before the point of service.
- Configure claim-scrubbing edits that catch technical errors before submission to the payer.
- Assign accountability for denial prevention to the department where the root cause originates.
- Train front-line staff on the documentation and authorisation steps that prevent common denials.
Session 2Appeals and Recovery
- Prepare first-level appeals with the clinical and documentation evidence each denial reason requires.
- Prepare for peer-to-peer review of medical necessity denials with payer medical directors.
- Track appeal deadlines and escalate to external or independent review when internal appeals fail.
- Measure appeal success rates by denial category to refine the prevention programme.
04Revenue Integrity Governance and Performance
2 sessions · 8 points
Session 1Building a Revenue Integrity Function
- Define the scope of a revenue integrity function spanning coding, charge capture and compliance.
- Align revenue integrity, coding, documentation and patient access teams under shared metrics.
- Build a compliance monitoring plan that addresses coding and billing regulatory risk.
- Use denial analytics dashboards to give department leaders visibility of their own performance.
Session 2Measuring and Reporting Revenue Cycle Performance
- Track denial rate, first-pass resolution rate and days in accounts receivable as core indicators.
- Benchmark cost to collect and denial overturn rate against prior-period performance.
- Report revenue integrity performance to finance and clinical leadership on a recurring cycle.
- Use performance trends to prioritise the next cycle of process and technology investment.
What the participant receives
4 course modules
A structured syllabus
8 training sessions
across 5 days
32 detailed points
Applied, detailed content
Accredited attendance certificate
On completing the programme
Complete your registration
We will contact you within one business day to confirm.
Ready to start?
Reserve your seat and start building the skill.