Working in the medical billing industry can be daunting at times. My last position as a follow up representative, proved to be the most challenging job that I have ever had. I have an extensive background in the medical insurance industry. I was aware of the way that claims were to be handled and submitted to insurance companies. The company that I had worked for had just won a contract for taking over the medical billing for twelve physicians in Portland, Oregon. Right off the bat, there were a variety of issues concerning how to bill the medical claims correctly. Claims have to be submitted on time, with the correct codes and information on them, before they can be processed by the insurance company.…
This is step four, reviewing coding compliance, which makes sure that all guidelines are followed while the codes are assigned. A diagnosis and procedure code are used in the patient’s account and entered in the patient ledger that updates their account information. Step five takes us to review the billing compliance; there are many types of fees for the services provided by a facility. Medical insurance specialists help by determining what a patient needs billed to them and what the insurance company should pay for. Checking out the patient comes next in the steps of bill processing. The payments for the patient visit are taken care of in this step while the patient is still in the office. The codes are completed, the balance has been figured, and now the charges are discussed with the patient. After everything is paid or billed, follow-up work is scheduled, and the patient is finished in the…
A patient’s experience comes from more than just what happens during the time of service. The experience is continued after when they are trying to get services paid by insurance or their self. A common misinterpretation of understanding why an insurance may pay or may not pay contributes to this. The billing department being able to explain these questions to a patient helps the satisfaction of the patient. According to the public opinion survey conducted by Copatient shows that 72% of Americans are confused by medical bills (Understanding Your Medical Bills, n.d.).…
An increasing issue within the health care field is the inability to collect debt from the growing population of uninsured or underinsured patients. Healthcare organizations may be struggling to meet operational margins because the industry has never treated its customers like other retail-oriented sectors of the economy. A McKinsy and Company report states that hospitals incur sixty billion dollars in bad debt annually because they typically collect only ten to twenty percent of a total uninsured patient balance after service. (MacKenzie, 2009) This is due to a number of reasons, including poor accounting practices or a lack of patient information. This paper will discuss how one hospital, California’s Sutter Health, has taken steps to correct this issue. It will analyze the accounting practices put into place by Sutter Health and the success of this practice. This author will also provide an alternate solution to the issue of debt collection for self-pay patients as well as an opinion concerning the actions taken by Sutter Health.…
This paper discusses the elements of financial management that is important to the healthcare organizations, generally accepted accounting principles, and a summary of the articles related to healthcare financial management.…
The receptionist or other clerical worker will either call, or receive a call from a “patient” or other authorized individual. During this communication, the associate must be careful to observe HIPAA rules related to “protected health information.” when “schedule, canceling, or rescheduling” encounters. When gathering benefit “information,” the representative must be diligent to accurately enter data into the “patient’s” file. Discerning insurance cards, policies, and all applicable guidelines of each plan are applicable to the “front and back” office. Abiding by the payer’s regulations, and the coordination of benefits,” associates will input this data into the patient management program (PMP). During these procedures, insurance specialists will be cautious to correlate the correct information with the correct patient. The “front or back office” will then confirm coverage with designated plans, along with all essentials, such as if a “referral or preauthorization” is a requisite. Prior to consulting with the physician, patients will need to be alerted about their rights, in coordination with HIPAA privacy standards, as well as those of the provider. During that time, if the patient owes any monies for coinsurance, or copayments, this will be submitted to the “front office.” While checking out patients, insurance specialists will transfer the descriptions of “diagnoses and procedures” from the “physician’s report” into appropriate “codes” for ‘claim” generation. This facet is most crucial, because of the HIPAA specifications regarding the transfer of PHI “by covered entities” (Valerius et al., p.…
When a claim has been processed and paid, the amount paid will have to be applied to the amount charged for individual patient’s treatment in the Medical Billing Software. This makes it possible for the billing office to track the payments received from different angles. The billing office would want to track the payments received based on differed criteria.…
There are times that the claims are not complete and are return to the medical office for further information. Because a lot of claims have been sent back to the medical office they have to come back with a decision that is evaluating compliance strategies in medical coding to keep the billing consisting and efficient.…
The compliance process is critical when it pertains to the billing and coding process. It is imperative for Medical Insurance Specialist to remain current on the patient’s participation in contract as well as the medical insurance policies, so there will not be any billing errors. Maintaining a communication with the payer will also prevent billing errors. Such regulations and laws are in place for to protect the patient’s financial state, prevent errors of billing and coding, and to link procedures and diagnoses correctly. Becoming knowledgeable of the billing rules should also help prevent billing errors as well. In this assignment, I will discuss how important it is for medical staff to be knowledgeable of the billing and coding compliance strategies.…
Financial Management is a fundamental part of successful healthcare financial planning. Financial decisions are a necessary part of day to day operations of any size or type of health care facility. These decisions are made in accordance with the facilities fiscal objectives and accounting practices. It is important that the individuals making these decisions follow proper reporting and ethical practices since these decisions affect the future of the entire facility. In order to make finical decisions it is important to understand generally accepted accounting principles, corporate compliance, ethics, fraud and abuse.…
The basic elements of an effective medical office financial policy are that it should be clear and concise and leave no room for misunderstanding. These policies should be posted in the patient waiting room, given to patient in a paper form and explained to patient so that they know what is expected of them. An effective medical financial policy will include every possible financial scenario and address effective ways to handle them that will not burden the medical office staff members nor embarrass the patient. The policies should coincide with state and federal updates. Co-payments,…
Keeping the staff members current with their training and up-to-date with the rules and regulations within a facility will keep the compliance plan for the medical records documentation standards…
Refer to Figure 15.1 on p. 487 of your textbook, the Internet, and the University Library as resources. Search for medical office financial policy advice as well as sample policies.…
The medical billing and coding process involves numerous tasks completed by all staff members of a medical facility to provide quality care while protecting the privacy of patients and expediting the payment of services. Ten steps are used to complete this process; pre-registration of patients, establishing financial responsibility for visits, check in of patients, check out of patients, review of coding compliance, a check of billing compliance, preparation and transmittal of claims, monitoring payer adjudication, generating patient statements and handling collections. During pre-registration, HIPAA policies are reviewed and signed by the patient to inform him or her of their rights and responsibilities; therefore, informing the patient of…
Proper, precise, and ethically sound financial management and reporting is required of all healthcare organizations. According to Wisconsin Government (1994), “agencies are required to have an effective financial management system as a condition of receiving federal funds. Federal and state rules and regulations establish several criteria that the financial systems of agencies receiving funds must meet” (Basic Elements of an Effective Financial Management System, para. 1).…