AR Calling and Denial Management in U.S. Revenue Cycle in Medical Billing RCM
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111 modules
English
Lifetime access
"Job-Ready Skills for AR Calling and Denial Management in U.S. Revenue Cycle"
Overview
AR Calling (Denial Management) in Medical Billing RCM is a comprehensive, training program designed to equip students and professionals with the practical skills required to succeed in the U.S. healthcare revenue cycle management (RCM) industry. This course focuses specifically on the Accounts Receivable (AR) follow-up process and denial management—a critical area where medical billing companies recover lost revenue by working with insurance providers to resolve unpaid or rejected claims.
In this course, you will learn the complete workflow of the U.S. medical billing process, with a deep focus on the AR calling function. You’ll gain a clear understanding of how health insurance works in the U.S., including the types of payers (Medicare, Medicaid, Commercial), common claim issues, and how to professionally follow up with insurance representatives to resolve those issues.
You will be trained in identifying and analyzing denial reasons such as timely filing, lack of authorization, medical necessity, coordination of benefits (COB), and more. Using real-world scenarios and mock calls, the course provides hands-on experience in making effective insurance follow-up calls, documenting call results, and taking appropriate next steps such as re-submitting claims or initiating appeals.
Whether you are a fresher, a graduate from any stream, or someone looking to shift into a more stable and rewarding career in the healthcare BPO industry, this course will prepare you for entry-level AR Caller roles with top medical billing companies.
Upon completion, students will be ready to attend interviews and perform effectively as AR callers in a real-world U.S. healthcare billing environment.
By the end of this course, students will be confident in handling AR calling tasks, managing unresolved claims, documenting call outcomes, and contributing directly to the revenue goals of any U.S. healthcare provider or billing company.
Key Highlights
Understanding AR calling process in medical billing
Strategies for effective denial management
Navigating the U.S. revenue cycle
Optimizing revenue flows through AR management
Handling claim denials and appeals efficiently
Enhancing revenue collection in healthcare RCM
Practical insights into denial resolution
Improving financial performance through AR
What you will learn
AR Calling Techniques
Master proven strategies for effective AR calling in U.S. medical billing RCM.
Denial Management Procedures
Learn best practices to handle denials and appeals efficiently within the revenue cycle.
Compliance Guidelines
Understand U.S. healthcare compliance regulations related to AR calling and denial management.
Modules
1.AR Calling Introduction
2. For Whom This Course is Designed
3. Who is an AR Caller and Basic Requirements to become an AR Caller.
4. The Future of AR Callers in the Medical Industry
5. What is AR (Accounts Receivable) and What is the Medical Billing Process
6. What is Revenue Cycle Management (RCM)
7. What Does the AR Team Do and Why Are There Unpaid Claims
8. 3 P’s in Medical Industry are Provider, Payer and Patient.
9. Premium
10. Benefits
11. Beneficiary
12.Subscriber
13.Dependent
14.Primary Care Physician (PCP)
15.HIPAA
16.NPI – National Provider Identifier
17. What is PTAN
18.Tax ID Number
19. CMS – Centers for Medicare and Medicaid Services
20. SSN – Social Security Number
21. MRN (Medical Record Number)
22. Account Number
23. Effective Date
24.Termination Date
25. Insurance Identification Number (Insurance ID)
26.Primary Insurance
27.Secondary Insurance
28.Tertiary Insurance
29.Coordination of Benefits (COB)
30.Medicare Crossover
31.Birthday Rule
32.Claim and What is a Corrected Claim
33.In-Patient
34.Out-Patient
35.Insurance Claim Number
36.Assignment of Benefits (AOB)1
37.Explanation of Benefits (EOB)
38. What is DOS (Date of Service) and Why is DOS important
39. Date of Bill
40.Billed Amount
41.Allowed Amount
42.Insurance Payable Amount
43.Write-Off Contractual Adjustment
44.Out-of-Pocket Expense
45.Deductible, Why deductibles exist and Cost Sharing
46.Co-Insurance
47.Co-Payment (or Co-Pay)
48.Balance Bill
49. Participating Provider (In-Network Doctor or Hospital)
50. Non-Participating Provider (Out-of-Network)
51. Credentialing
52. Fee Schedule
53. Contract Maximum
54. Referral
55. Pre-Authorization Pre-Certification
56.Claim Form Types CMS-1500 , UB-04
57.Type of Bill (TOB)
58. Place of Service (POS) and Common Place of Service Codes
59. Claim Filing Limit
60. Capitation
61. Durable Medical Equipment (DME)
62. Diagnosis-Related Groups (DRGs)
63. Ambulatory Payment Classifications (APC)
64. CLIA – Clinical Laboratory Improvement Amendments
65. What is an ABN, What Must Be Included in a Valid ABN
66. Medicare , Who is Eligible for Medicare, Parts of Medicare
67. Medicaid, Who is Eligible for Medicaid
68. Worker’s Compensation (WC) , Who Pays for It
69. TRICARE (formerly CHAMPUS) , What Does TRICARE Do
70. CHAMPVA, What’s Covered
71. Commercial Insurance (Private Insurance), PPO , HMO
72. Commercial Insurance (Private Insurance), POS, EPO
73. COBRA, How Long Does COBRA Last
74. The Affordable Care Act (Also Known as ObamaCare), Main Goals of the Affordable Care Act
75. What is Medical Coding and Why Coding is Important
76. What is Medical Transcription and Why is Medical Transcription Important
77. ICD – International Classification of Diseases and Why is ICD Important
78. Current Procedural Terminology – 4th Edition (CPT) and Why is CPT Important
79.HCPCS – Healthcare Common Procedure Coding System
80.What Are Revenue Codes and Why Are Revenue Codes Important
81.What Is a Global Surgical Fee , Major vs. Minor Surgeries
82.What Are Modifiers in Medical Billing , Common Modifier Examples
83. Sections of CPT Codes (Current Procedural Terminology)
84. Who is a Fresher AR Caller,What Does a Fresher AR Caller Do
85. What Does an AR Caller with 2 Years of Experience Do, What is Expected from a 2-Year Experienced
86. What is EOB, What does an EOB show
87. What is ERA
88. What is Overpayment, What is Underpayment
89. OFFSET , RECOUPMENT , REFUND
90. Most Common Denials in AR Calling
91.Top Questions AR Callers Should Ask When a Claim Is Denied
92.What is Root Cause Analysis (RCA) for Denials, Common Areas to Check During RCA
93.What does “Claim Not on File” mean , Possible Reasons Why a Claim is “Not on File
94.What is a Duplicate Claim , Why Does a Duplicate Claim Happen
95.What Does “InvalidMissing Patient Information” Mean
96.What Does “EligibilityPolicy Not Active” Mean , Common Reasons for This Denial
97.What is Invalid or Missing AuthorizationReferral, Common Reasons for Denial
98.What is Retroactive Authorization , When is Retroactive Authorization Allowed
99.What Does Procedure Not Covered Mean
100. What is “Timely Filing Limit Exceeded
101. What is Coordination of Benefits (COB)
102. What is Bundled Services
103. What Does Incorrect or Missing Modifier Denial Mean
104. What is a Medical Necessity Denial
105. What is an Out of Network Provider , Reasons for Denial due to Out of Network Provider
106. What is Patient Responsibility , Why Claims Show Patient Responsibility
107. Why Claims Get Denied for Incorrect CPTICD Codes
108. What Does “Claim Denied as Paid” Mean
109. What Does “Maximum Benefits Exhausted” or “Met” Mean
110. What Are Non-Covered Services
111. Pro Tip for AR Callers
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