Within the medical billing process, compliance plans help prevent fraud and abuse from occurring and any repeat violations from happening. The medical records will also be accurate and complete and the documentation standards will be met by both the staff members and physicians within the compliance plan.…
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.).…
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.…
There are ten steps included in the billing process and are used to help process the patient’s information from preregistration to the follow up payments. Each patient has the responsibility to pay for their services once they have received care from a facility by themselves or an insurance company. Many different health insurance companies that may help an individual cover their medical expenses or even pay the entire bill. This billing process is usually done in the back office whereas the registration and collection of information is done in the front office.…
2. Establish Financial Responsibility – When a patient has insurance; the health plan coverage should be reviewed and eligibility needs to be verified (Valerius, Bayes, Newby, & Seggern, 2008). It should also be determined whether or not there is more than one insurance company. If that is the case, the first payer should be determined. Check to verify that all conditions for payment have been met and the correct steps followed to assure payment for service (Valerius et al.).…
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.…
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.…
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.…
The medical billing process and all of the functions that pertain to it are the responsibilities of the medical insurance specialist. It addresses all tasks that will be performed by the administrative staff members during the medical billing process. These functions are typically handled by front office staff members such as the receptionist (registration) and scheduling.…
It is a very long process for billing to prepare the bill that is required to submit for payment. There also have been a lot of mistakes when billing because some did not know the guidelines of medical coding when sending the bill to the insurance company. This assignment will show how to making medical billing and compliance strategies so mistakes will not be made. Even through that not any means is any one perfect…
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 health care industry is a multi-million dollar industry. Health insurance, providers, technology management, and inpatient and outpatient procedures are among the many terms that we hear nowadays within this industry. The principal phrase that seems to be ringing in the ears of the government and policymakers are debt and cost-control. There are fundamental concepts that should be understood throughout the health care industry as it relates to finance. On one hand, many individuals have a general knowledge concerning health care organizations from the standpoint of insurance, copays, and deductibles. These constructs are more familiar to a person that has any health care needs due to the routine of having to provide some form of payment…
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).…
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.…