Revenue Cycle Tutorials
Thirteen interactive guides to the work that turns patient care into payment: from scheduling and credentialing, through coverage, authorization, coding and the claim, to posting, denials, patient balances, compliance, value-based care and the analytics that measure it all. Each tutorial has 14 chapters, hands-on tools built on realistic examples, a searchable glossary and a short quiz.
Where each tutorial sits in the revenue cycle
- Front endScheduling and registrationTutorial 04
- Front endEligibility, benefits and COBTutorial 01
- Front endPrior authorizationTutorial 02
- Front endCredentialing and enrollmentTutorial 05
- MiddleCoding, charge capture, CDITutorial 06
- Back endClaim submission and adjudicationTutorial 03
- Back endContracts and reimbursementTutorial 07
- Back endPayment posting and reconciliationTutorial 09
- Back endDenials, appeals and auditsTutorial 08
- Back endPatient billing and collectionsTutorial 10
- AcrossCompliance and program integrityTutorial 11
- AcrossRisk adjustment and value-based careTutorial 12
- AcrossAnalytics and technologyTutorial 13
Tutorials
Suggested order: 01 → 02 → 03, then 04 onward in cycle order
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Front end01
Eligibility, Benefits and Coordination of Benefits
Confirm coverage, learn what the plan will pay, and work out which plan pays first.
- Plan types and payers, from HMO to Medicare and Medicaid
- Reading a 270/271 eligibility response line by line
- NAIC and Medicare Secondary Payer COB rules, and claim math
271 decoderCOB order finderClaim math14 chapters · 4 tools · 8-question quiz Open tutorial -
Front end02
Prior Authorization
Know when an auth is needed, build a request that gets approved, and carry it to the claim.
- Who requires PA, including Medicare's OPD, DMEPOS and WISeR programs
- The 278 transaction, decision clocks, peer-to-peer and appeals
- The 2026 CMS rules and the 2027 FHIR API deadline
Auth checkerDeadline calculator278 decoderDenial triage14 chapters · 4 tools · 8-question quiz Open tutorial -
Middle and back end03
Claims and the Claim Lifecycle
Follow a claim from the encounter through coding, adjudication and remittance to a zero balance.
- CMS-1500 vs UB-04, the 837 and 835, and reason codes
- Denials, corrected claims and Medicare's five appeal levels
- A/R management and the KPIs that measure the cycle
837 decoderRemittance mathFiling deadlinesKPI calculator14 chapters · 4 tools · 8-question quiz Open tutorial -
Front end04
Patient Access and Financial Clearance
Get the registration, coverage, notices and estimate right before the patient arrives.
- Registration and identity, insurance capture, the MSP questionnaire
- ABNs and the other Medicare notices, good faith estimates, price transparency
- Point-of-service collections, financial counseling and registration quality
MSP decision treeABN helperPatient estimateAccuracy scorecard14 chapters · 4 tools · 8-question quiz Open tutorial -
Front end05
Provider Credentialing and Enrollment
Get every provider verified, privileged and enrolled before the first claim goes out.
- NPI, taxonomy, CAQH and primary source verification
- Medicare enrollment in PECOS, Medicaid and commercial payer enrollment
- Timelines, revenue at risk, revalidation and locum tenens billing
NPI and form chooserPacket builderRevenue-at-risk calculatorRevalidation tracker14 chapters · 4 tools · 8-question quiz Open tutorial -
Middle06
Medical Coding, Charge Capture and CDI
Turn the clinical record into accurate, complete and compliant codes and charges.
- ICD-10-CM and PCS, CPT and HCPCS, modifiers and global periods
- E/M leveling, NCCI edits, MS-DRGs and APCs
- Chargemaster governance, charge capture and the CDI query
E/M level helperModifier chooserNCCI and MUE checkerDRG impact illustrator14 chapters · 4 tools · 8-question quiz Open tutorial -
Back end07
Payer Contracts and Reimbursement
Understand how each service is priced, model what a contract should pay, and recover underpayments.
- Fee schedule, DRG, APC, per diem, capitation and value-based methods
- Anatomy of a payer contract and the 2026 Medicare rates behind it
- Expected reimbursement modeling, variance finding and negotiation
RVU calculatorMS-DRG calculatorContract comparisonVariance finder14 chapters · 4 tools · 8-question quiz Open tutorial -
Back end08
Denials, Appeals and Payer Audits
Classify every denial, win the appeals worth winning, and survive the audits.
- The denial taxonomy, root causes and prevention by stage
- Writing appeals, peer-to-peer, and the appeal paths by payer
- RAC, TPE, UPIC and commercial audits, ADRs and extrapolation
Root-cause classifierExpected-value prioritizerAppeal deadline trackerADR and extrapolation14 chapters · 4 tools · 8-question quiz Open tutorial -
Back end09
Payment Posting, Reconciliation and Credit Balances
Post every dollar from the 835, balance it to the bank, and refund what is not yours.
- Reading an 835 in depth: CLP, CAS, SVC, PLB
- EFT and ERA operating rules, takebacks and month-end close
- Credit balances, refunds, the 60-day rule and escheat
835 decoderPLB and takeback posterRemit-to-deposit reconcilerCredit balance classifier14 chapters · 4 tools · 8-question quiz Open tutorial -
Back end10
Patient Billing, Collections and Financial Assistance
Collect what patients owe fairly, with the protections and assistance the law requires.
- The patient as payer, statements, payment plans and propensity to pay
- Financial assistance under 501(r), presumptive charity, bad debt
- No Surprises Act, QMB, credit reporting and collection agency rules
Propensity-to-pay segmenterPayment plan calculatorAssistance estimatorCollections timeline14 chapters · 4 tools · 8-question quiz Open tutorial -
Across the cycle11
Compliance and Program Integrity
Keep every claim defensible: the laws, the program elements and the self-correction rules.
- The seven elements, the False Claims Act, Anti-Kickback and Stark
- Exclusion screening, the 60-day rule and self-disclosure
- HIPAA in billing, risk areas, auditing and sampling
FCA exposure illustratorArrangement screener60-day clockRisk self-assessment14 chapters · 4 tools · 8-question quiz Open tutorial -
Value-based care12
Risk Adjustment and Value-Based Care
How payment follows risk and quality, and what the revenue cycle must do differently.
- CMS-HCC V28, RAF score math, documentation and RADV audits
- ACOs and shared savings, Star ratings, MIPS and the TEAM model
- How RCM teams support value-based contracts
RAF calculatorHCC documentation checkerShared savings calculatorQuality bonus illustrator14 chapters · 4 tools · 8-question quiz Open tutorial -
Across the cycle13
RCM Analytics and Technology
Measure the cycle with HFMA MAP Keys, forecast cash, and choose automation that pays.
- All 29 MAP Keys, dashboards, data sources and denial analytics
- A/R aging, cash forecasting, work queues and staffing metrics
- The technology stack, interoperability, AI and ROI
MAP Key calculatorCash forecastWork queue scorerAutomation ROI14 chapters · 4 tools · 8-question quiz Open tutorial
Start with 01. Eligibility and coordination of benefits are the foundation that prior authorization and claims build on.
Every tutorial has calculators and decoders with realistic sample data. Change the inputs and watch the results; that is where most of the learning happens.
Each tutorial ends with a glossary you can filter and an 8-question knowledge check with explanations.