Billing And Coding In Health Care Essay

Medical biller is a position that will require you to take in medical claims and code them and bill out medical claims to insurance companies, Medicare and Medicaid on a daily basis. You will have to reconcile Explanation of Benefits (EOB) weekly. Verify if insurance companies require that patients get PA for certain procedure and products. Five requirements for Medical Biller position 1. How to bill claims 2.

For example, hospitals can ensure that all written policies for assisting low-income patients are applied consistently. In addition, hospitals can review their current charge structures and ensure that they are reasonably related to both the cost of the service and to meeting all of the community’s health care needs. Finally, hospitals could also implement written policies about when and under whose authority patient debt is advanced for collection. The Financial Impact of MACRA

CMO continues to meet weekly and as needed with division leaders to identify issues and factors that need to be addressed in order to ensure the appropriate operational approaches that should impact clinician as well as client satisfaction and therefore better outcomes. 1. Ongoing in-services for our prescriber staff in the use of our Electronic Health Records (EHR) continue to translate into improvement of the required content in order to justify appropriate billing codings to enhance our collection rates. Chief Medical Officer has personally being reviewing a random number of cases per provider and meeting with them individually to provide feedback and improve their performance. This should also impact obtaining the documentation needed for appropriate coding and improved collections.

If an invoice comes in regarding something that is not required for the patient to have a special approach is taken to state, why they will not be covering this bill then they return it to that office. This job requires a lot of organization. Once an invoice comes in they do not automatically pay them, therefore the stack of invoices becomes big toward the end of the month. I also sat with a lady named Nelda, that covers all the financial statements except the bank reconciliation. I was able to see the format that is used to get all of these reports ready for the end of the month.

Electronic Medical Records has several positive effects on the billing and coding process. For example, Electronic Medical Records helps to reduce cost for physicians and improve care for patients. Electronic Medical Records helps reduce medical errors for the physicians and unneeded diagnostic tests. The EMR can also help coordinate patient's information better such as diagnosis, medications, family history, and the test results of each patient on file. Electronic Medical Records helps to improve storing health information and EMR makes it easier to track results of each patient.

Fraud is all around us. Especially in the health care industry. What is being done to prevent fraud from reoccurring over and over in the health care industry? In the article “New medical codes can better catch fraud, but training is needed” by Tami Rockholt, RN, BSN; Mike Fossey; Mary McLean, BS discuses the topic of health care organizations transferring from ICD-9 to ICD-10 to help decrease fraud in the coding and billing department.

In-house vs. Outsourced Medical Billing Services A never-ending challenge for a physician is to decide whether to outsource the medical billing services to a third-party or to keep the medical billing process in-house that winds up heavily on a healthcare provider. This explicitly differs from practice to practice and is based on several factors: • Duration of the business • Size of clinical staff • Financial health of a healthcare organization Medical Billing often referred as Revenue Cycle Management (RCM), includes the most complex and crucial components of a healthcare business. The advents of latest inventions in technology, increasing government regulations, and uncollectible accounts have ignited a new trend leading to an increased

Healthcare Options – (HRA) Health Reimbursement Accounts Health Reimbursement arrangement (HRA) is an employer-funded medical reimbursement plan for employees. Health Reimbursement accounts is designed by the Internal Revenue Service (IRS) to enable employers reimburse their employees for certain medical expenses. This helps the employee settle the cost of their medical expenses. Additionally, it also help the employer save money on taxes. Who can benefit from Health Reimbursement arrangements?

Unlike nursing, medical coding has nothing to do with saving lives. Medical coding to put it in simplest terms, is a clerical job. But, it is a profession that must have a certified individual, subsequently, any discrepancies from the coder could mean potential harm to both patient and medical facility. Additionally, medical coding is a profession that necessitates an elevated level of detail-oriented work.

The career path I am taking after graduation is medical billing and coding. The main duty of billing and coding specialists is to accurately provide services to patients. My duties as a medical billing records specialist would be to help protect a patient 's rights and health care system to run efficiently. A Certified Billing and Coding Specialist 's main focus is on translating a medical procedure, analysis, or symptom into distinctive codes for submitting a claim for repayment. Pursuing a career in medical billing and coding you should have the following skills detail oriented, discretion, assertive, analytical, and technical.

I would be responsible for ensuring that the medical providers are getting the correct amount of money that they deserve for their services they gave their patients (“Medical Coder”). “Coders earn an average of $35,000 to $50,000 dollars a year (“Medical Coder”)”. The more experience that I have as a coder the more money I will make. “Experienced coders earn 21% more than non-experienced coders (“Medical Coder”)”. The hospitals are planning to hire more coders in order to make sure that the billing and payments getting sent out do not fall because of the new coding program, ICD-10, they will be switching to in the beginning of October of 2015(Thompson).Because of so many shortages on people with the experience in coding, Medical coding jobs are in high demand (Thompson).

For instance, optimize cost and clinical outcomes, and for a hospital and physician to work under a cohesive structure. Now we will discuss the

Coronis health leadership team has discussed implementing of Radiology billing. Radiology billing is unique, and the radiologist are not client facing in most cases. Of course, there are those special radiological procedures where a radiologist is in the room, but for radiology billing. The radiologist is obtaining billing information passed on from a hospital or surgery center facility. It is hard enough to obtain correct information from the patient when the patient is sitting in front of you.

The Importance of Accountability Why is Accountability so important in the health care industry? Even though a situation may be positive or negative, every aspect of health care needs to be credited to something or someone, with accountability, errors can be fixed and then prevented and helps keep costs down. An employee accountability is measured by customer satisfaction, results of performance, and the cost and impacts of the employee over time, and affects an organization’s working culture by their values, integrity and work ethics. A successful organization follows the checks and balance process, maintains a positive working culture, and stays clear from blame.

Health care cost has seen to increase gradually as years go by. This has been influenced by major factors such as political influence, emerging chronic diseases, new procedures that are coming up including the technologies being invented for treating illnesses, pricing of medicines and treatment is not regulated and when treating ailment their may arise repetition of tests or a patient gets over treated for a particular ailment. The cost of healthcare has increased due to chronic diseases such as cancer and diabetes etc. The lifestyle people are living in this generation has led to the development of diseases that are expensive to treat or has led to there being over treatment in such for a cure of a particular ailment.