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Institutional Medical Billing and Revenue Cycle Management

Name: Institutional Medical Billing and Revenue Cycle Management
Rating: 4.6 (15 reviews)

Master Institutional Medical Billing, Revenue Cycle Management, CMS 1450, UB 04, Facility Claims, Medical coding, & More

Created byRCM Academy

Last updated 9/2025

English

What you'll learn

Map the full Institutional Billing workflow from registration to payment posting
Complete and validate the UB-04 / CMS 1450 form with real-world accuracy
Create clean 837I transactions and understand EDI handoffs to payers
Distinguish Medicare Part A facility rules from professional billing rules
Work facility claims through edits, scrubs, submissions, and remits (ERA/EOB)
Perform AR calling, follow-ups, and timely filing best practices
Execute payment posting, adjustments, refunds, and balance transfers
Triage rejections & denials, write effective appeals, and reduce avoidable write-offs

Course content

9 sections • 50 lectures • 2h 13m total length

What is Institutional Billing?3:10
Institutional Billing vs. Professional Billing (CMS 1450 vs. CMS 1500)2:54
Differentiate institutional billing from professional billing by comparing CMS 1450 (UB-04) and CMS 1500 forms, their covered services, and their structure for facility versus provider billing.
Who Uses the CMS 1450 (UB-04) Form?2:51
Types of Facilities Using UB-04 (Hospitals, SNFs, Home Health, etc.)2:44
Learn how UB-04 claims flow from hospitals, SNFs, rehab centers, and home health agencies, with per diem, daily, or episode billing and revenue codes that drive reimbursement.
Payers Involved in Institutional Billing (Medicare Part A, Advantage, Commercial3:04

Medicare Part A: Inpatient & Facility Services Explained2:55
Medicare Advantage Plans: Billing Nuances and Caveats2:44
The Role of Medicaid and Dual Eligibility2:34
Commercial Insurance Plans in Institutional Billing2:38
Payer Rules and Coverage Criteria for Facilities2:41
Learn how facilities navigate payer rules and coverage criteria for Medicare, Medicaid, commercial payers, and Medicare Advantage, aligning documentation and coding with medical necessity to prevent denials and support appeals.

Key Players in Institutional RCM2:40
Patient Access and Registration Workflows2:26
Improve revenue cycle outcomes by securing accurate patient data, including insurance details and demographics, during scheduling, pre-registration, and registration. Close coordination between front desk and billing prevents claim denials.
Insurance Verification and Eligibility for Facilities2:35
verify active insurance and eligibility for facilities to prevent denials, delays, and write-offs by confirming coverage dates, co-pays, deductibles, and authorization requirements.
Charge Capture & Charge Master (CDM) for Facilities2:30
Coding for Institutional Billing (ICD-10-PCS, Revenue Codes)2:38
Learn how inpatient procedure coding with ICD-10-PCS works and how revenue codes on UB-04 claims justify payments, supported by clinical documentation and audits for compliance.

UB-04 Form Layout and Structure2:47
Explore the UB-04 CMS 1450 form layout, form locators, and how patient information, payer details, services rendered, charges, and diagnosis codes guide facility claim submission.
Differences in Electronic vs. Paper CMS 1450 Claims2:35
General Rules and Guidelines from NUCC and NUBC2:31
Explore how Nubc maintains the UB-04 institutional claim form, defines field locators, revenue codes, and CMS policy updates, and how Nucc guides the CMS 1500 professional claims in hybrid billing.

Billing Provider & Claim Basics (Boxes 1–6)3:45
Patient Demographics (Boxes 8–11)2:44
Admission & Discharge Info (Boxes 12–17)2:43
Condition & Accident Details (Boxes 18–30)2:21
Occurrence Details (Boxes 31–36)2:15
Internal Tracking & Responsible Party (Boxes 37–38)2:12
Identify box 37 internal control number for internal tracking and efficient claim management. Determine box 38 to designate the financially responsible party, improving payment clarity and collections.
Value Codes & Amounts (Boxes 39–41)1:45
Service Line Details (Boxes 42–49)3:05
Payer & Payment Info (Boxes 50–55)2:33
Provider Identifiers (Box 56–57)1:54
Subscriber & Policyholder Info (Boxes 58–65)3:13
Diagnosis Info (Boxes 66–68)2:31
Admission & Injury Coding (Boxes 69–72)2:49
Procedures (Box 74a–e)2:07
Record the principal procedure and date for an inpatient stay with ICD-10-PCS codes, then list up to five additional procedures with codes and dates to support medical necessity and reimbursement.
Physicians & Remarks (Boxes 76–81)3:09

DRG and APC Payment Systems2:30
Compare DRG and APC payment systems for inpatient and outpatient billing. DRGs bundle inpatient care at a fixed rate; APCs price outpatient services per service, requiring accurate coding and documentation.
Medicare Cost Reporting and PPS Impact2:27
Learn how Medicare cost reports to CMS influence PBS-based rates, future reimbursement formulas, and wage indices, through accurate documentation and cross-functional collaboration.
Revenue Code vs HCPCS Conflicts2:51
Split Billing and Interim Billing3:02

Requirements

Basic familiarity with healthcare billing or admin (helpful, not required)
Reliable internet and a desktop/laptop for practice activities
Willingness to learn payer rules (especially Medicare Part A) and documentation standards

Description

Institutional Medical Billing and Revenue Cycle Management gives you a practical, end-to-end path to mastering Institutional Billing, the UB-04 / CMS 1450 form, 837I EDI files, Medicare Part A rules, facility claims workflows, AR calling, payment posting, and denial management for hospitals and facilities. If you’ve been searching for a hands-on guide to compliant, efficient Revenue Cycle Management (RCM) in institutional settings, you’re in the right place.

This course is designed to help learners of all backgrounds understand and apply the processes, forms, data files, and payer rules that drive facility reimbursement. Whether you're working in hospital billing, an ambulatory surgery center, skilled nursing, home health, or hospice, the program builds strong operational fluency in the language and mechanics of institutional RCM — with a focus on practical usage, not academic theory.

You’ll learn how claims move from patient registration through coding, charge capture, scrubbing, submission, remittance, and follow-up; how to complete and validate the UB-04 (CMS 1450); and how to create clean 837I transactions through clearinghouses and payer portals. We’ll also compare Medicare Part A facility rules to professional billing, unpack common denial codes, and practice high-impact AR workflows that accelerate cash.

Designed to be beginner-friendly, this course offers clear explanations, job-ready checklists, and realistic examples from claims, remits, reconciliation reports, and payer correspondence to reinforce learning. No prior facility billing experience is required.

What You’ll Learn

Complete and quality-check the UB-04 / CMS 1450 form
Build and transmit clean 837I files and interpret payer/clearinghouse responses
Apply Medicare Part A policy and coverage rules to facility claims
Reconcile ERAs/EOBs and perform accurate payment posting and adjustments
Run effective AR calling and follow-up sequences with timely filing control
Decode common rejections vs. denials and write concise, persuasive appeals
Use reports to monitor clean claim rate, DSO, denial rate, and cash acceleration
Implement compliance-first workflows that reduce risk and rework

Course Features

Structured walkthrough of the institutional RCM lifecycle with real artifacts
UB-04 field-by-field guidance, plus quick-reference checklists and job aids
Hands-on 837I/EDI concepts, clearinghouse logic, and remit interpretation
Denial prevention playbooks and appeal templates for high-frequency issues
Beginner-friendly explanations; suitable for ESL learners and career switchers
Mobile/desktop access with downloadable resources you can use on the job

Who This Course Is For

Aspiring and current facility billers and RCM specialists
Hospital/ASC/SNF/home health/hospice revenue cycle teams
Administrative professionals moving into institutional billing
AR, posting, and denial management staff seeking a proven framework

This course serves as a practical, professional introduction to Institutional Billing and Revenue Cycle Management — especially if you're preparing for a facility-side role or need a confident grasp of UB-04, 837I, Medicare Part A, and payer workflows. Whether you're new to the field or brushing up, you'll leave with job-ready tools to submit cleaner claims, post payments correctly, and win more denials.

Disclosure: This course contains the use of artificial intelligence for clear voiceovers.

Who this course is for:

New and aspiring facility billers and RCM specialists
Hospital, ASC, SNF, home health, or hospice billing staff
Office admins transitioning from professional to institutional billing
AR follow-up and payment posting teams seeking structure and speed
Coding/billing students preparing for entry-level facility claims roles
Managers cross-training teams on UB-04, 837I, and denial prevention

Institutional Medical Billing and Revenue Cycle Management

What you'll learn

Explore related topics

Course content

Introduction to Institutional Billing5 lectures • 15min

Understanding Medicare for Facility Billing5 lectures • 14min

Institutional Revenue Cycle Management Overview5 lectures • 13min

UB-04 CMS 1450 Form Overview3 lectures • 8min

Box-by-Box CMS 1450 (UB-04) Field Breakdown15 lectures • 39min

Common Scenarios and Case Studies5 lectures • 13min

Rejections, Denials & Resubmissions4 lectures • 11min

Advanced Topics in Institutional Billing4 lectures • 11min

Compliance and Legal Aspects4 lectures • 11min

Requirements

Description

Who this course is for: