Wait a second!
More handpicked essays just for you.
More handpicked essays just for you.
Essays on communication and interpersonal skills in relation to professional practice
Don’t take our word for it - see why 10 million students trust us with their essay needs.
Medical Billing and Coding Outline Introduction What is the difference between a Medical Biller and a Medical Coder? The answers to this and a few other questions, about the related fields, will be provided here to inform the career curious and undecided individuals. Although, both fields are a little different, they both require good communication and self-esteem, among other similarities. Content Sub-topic 1: • Medical billing transforms health care services into billing claims. The responsibility of the biller is to follow that claim to ensure the physicians, hospitals, third party billing companies, as well as federal and state governments receive reimbursement for the work that is provided. An experienced biller can boost revenue performance for the facility while keeping the business running smoothly. • The biller normally gathers all data concerning the bill including claims transmission, payment posting, charge entry, insurance follow-up and patient follow-up. • Medical billers often communicate with physicians and other health care professionals to explain diagnoses or to attain further information by means of phones, email, fax, etc. The biller must know how to read a medical record and be familiar with CPT®, HCPCS Level II and ICD-9-CM codes. • A certified medical biller is one who passes the Certified Medical Reimbursement Specialist Exam and because of the certification, they are greatly sought after. Medical billing presents the chance for a well-organized, task-oriented individual to use her eye for specificity in a crucial role within the health care industry. A biller with a good sense of self-concept can communicate effectively because they are confident in themselves, they can accurately rea... ... middle of paper ... ... health organizations, consulting firms, independent billing and coding services, and government agencies. The majority of medical coding specialists work in an office building or in the back office of a hospital or clinic. Off-site coding positions exist, but they are rare and usually require many years of successful work experience. Conclusion Now, although I am going to be both a Medical Biller and Coder, it is important to note the differences between the two. Having good self-esteem will aid me with communicating effectively with my patients or clients. Strong self-talk is helpful with communication and the medical field because you will always be ready and confident and pepped up at your job and in life. Professionalism in writing format may also be of value to me, as far as building on personal abilities for effective communication.
On the basis of the clinic’s previous collections experience, Dough was able to convert billings for medical services into actual cash collections. On average, about 20% of the clinic’s patients pay immediately for services rendered. Third-party payers pay the remaining claims, with 20% of the payments made within 30 days and the 60% remainder (of total billings) paid within 60 days. For monthly budgeting purposes, 20% are assumed to be collected one month after the billing month, and 60% are assumed to be collected two months after the billing month.
Healthcare professionals: Seek the beneficence and nonmaleficence of the patient by giving them truthful and accurate documented services and charging fair legal rates according to standard industry protocols that are reproducible, verifiable, and truthful for the services
Physicians in this co-management arrangement are paid by the hospital based on fixed duties developed beforehand. This payment method is important for the enactment of co-management. The fixed-fee structure works in coordination with a clear set of administrative tasks that physicians must complete for the purpose of refining quality, patient safety, and operations of the service line. When these tasks and performance metrics are developed in the contract, leadership must describe the effort or hours that were required to completed these fixed duties
– Health care providers who transmit health information in electronic form for certain standard transactions.
The chargemaster is an integral element of the revenue cycle. It is used in generating charges for services that are rendered to patients in real time, the absence of functioning chargemaster can result in potential collapse of the revenue cycle. Hence, the process to optimize revenue cycle must include optimizing the chargemaster and all services that is associated with it. The negative consequences of nonfunctioning chargemaster can include excessive payment/overcharging, inaccurate billing to patients; and can result in stiff penalties and fines (Bielby et al,
...ntal hygienists do not only have jobs that have a great salary and have more flexible hours than almost any other career out there, but they also have a job that helps people too. If one was to become a dental hygienist, at the end of the day they would be a lot more proud of this than anything else (“Dental Hygienists” Coin Career).
Langenbrunner, J., Cashin, C. & Dougherty, S. (2009). Designing and implementing health care provider payment systems how-to manuals. Washington, D.C: World Bank.
Healthcare professionals associated with medical billing and coding know the progress the technology has made so far. In the last few decades, medical billing and coding has switched from being a paper-based system to a computerized format. Under HIPAA laws, medical practitioners had to develop new software in order to send out electronic bills. With the advent of electronic medical records (EMR), with one touch of a button, doctors, Nurse Practitioners and PAs can gain access to all the care a patient has ever received from every healthcare facility the patients visited previously and can figure out possible illnesses. This enables statistical documentation of the population as a whole as well. EMR can also make the healthcare system more transparent and allow integration with reimbursement data. As the healthcare system changes, this will prevent unnecessary costs and make it easier to get the reimbursements needed to treat a patient.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
The goals for NHIN are to achieve nationwide health information exchange through the vision of utilizing information technology solutions to cut costs, avoid medical mistakes, and improve health care in America through the goals of informing clinical practice, interconnecting clinicians, personalize care, and improving population health. The pros to these goals are that of identifiers. The physician’s identity is authenticated via his or her provider number issued by the payer to whom the claim will ultimately be submitted. The identity of the patient to whom care was delivered is authenticated via his or her payer-issued member number. The clearinghouse only needs to validate those two pieces of information and the accuracy of the claims codes before submitting the claim to the payer on behalf of the provider. (Roop, 2008) Also NHIN provides simplicity, faster access to data, better privacy, and data appearance in uniform.
Fee-for-service is a retrospective reimbursement system in which providers create a comprehensive list of services they provided to a patient and the materials, supplies, and facilities they used to provide those services and then bill the patient’s insurer (or the patient, if he/she is self-pay) for each item on the list (Cellucci et al., 2014). Traditionally physicians were reimbursed on a fee for service basis. In a fee for service arrangement, physicians were paid based on the numbers of services administered to the patients. Fee for service gave providers an incentive to provided more treatment because payment was dependent on the quantity of care rather than the quality of care. Some of the disadvantages of
The balance between quality patient care and medical necessity is a top priority and the main concern of many of the healthcare organizations today. Due to the rising cost of healthcare, there has been a change in the focus of reimbursement strategies that are affecting the delivery of patient care. This shift from a fee-for-service towards a value-based system creates a challenge that has shifted many providers’ focus more directly on their revenue. As a result, organizations are forced to take a hard look at the cost of services they are providing patients and then determining if the services and level of care are appropriate for the prescribed patient care.
Working as medical and healthcare service requires some qualities like communications skill to communicate effectively with other medical professionals and staff. The interpersonal leadership they are the one in charge to hired and train staff. They need to be detail orientated since they are the one in charge of overseeing that the organization runs smoothly.
An area I believe I need to improve on is my communication skills; looking for opportunities to interact with patients, family members, nurses and doctors. I need to practice professional communication skills, with all these people, adjusting the terminology and level of detail to be right for the person I am communicating with, and asking more questions to get more information about my
As patients assume more responsibility for health costs in consumer-driven care models, hospitals are simplifying prices and billing statements. (Robinson & Ginsburg, 2007). Bills include all chargeable items in a charge master. (2007). The finance department modifies charges to earn profits, to respond to inflation, to account for expensive equipment and resources, and to survive competition. (2007). Hospitals adopt “pricing transparency” and provide more precise costs for specific services. The Health Care Price Transparency Promotion Act of 2007 “builds on existing state efforts to report hospital pricing information, requires insurers to disclose estimated out-of-pocket costs to consumers and requests that the Agency for Healthcare Research and Quality study the types of price information that consumers want and would find useful in making decisions.” (2007) The American Hospital Association supports these efforts and has “partnered with the Healthcare Financial Management Association on the Patient-Friendly Billing project to help promote clear, concise and correct financial communications.”