Module 1: The Revenue Cycle
How a clinical encounter becomes a paid claim, who the parties are, and where practices actually lose money.
What You'll Learn
- The difference between medical coding and medical billing
- The eleven steps from patient registration to collected payment
- The metrics that reveal a practice's billing health
- Payer types, network status, and how patient responsibility is calculated
Real-World Scenario
Lakeside Medical Associates billed $840,000 last quarter and collected $611,000. The gap is not one large problem but roughly nine hundred small ones — denied claims, underpayments, uncollected patient balances, and claims that quietly aged past the filing deadline. Your first job is to understand the system well enough to see where the money is going.
Lessons
Complete each lesson in order. Watch the video, review the notes, and finish the challenge.
What Medical Billing and Coding Actually Is
Understand the two distinct jobs behind the title, how they relate, and why a clinic cannot get paid without both being done well.
The Revenue Cycle and Where Money Is Lost
Follow the money through a medical practice, and learn where revenue actually leaks — usually far earlier in the process than people expect.
Payers, Providers, and Patients
Learn who the parties in a healthcare transaction are, what each one is trying to achieve, and why the rules differ so much between them.