Coder Interview

Charges – This is the financial obligation made to a patient’s account for services rendered.

It is essential for an administrator to understand how private and government payers impact actual reimbursement. Government payers have a standardized benefit structure. The one benefit is that registration staff have an easier time calculating payment due (copayments) for service and can set up payment arrangements. Since the most significant proportion of funds coming into a healthcare organization is usually payments from third-party payers, therefore, it is critical to know how each reimbursement affect the others that come in. Healthcare organization may have hundreds of different payer’s relationships in the form of different contracts that have their own rates of payment that are usually different from other payers for an identical

Once the patient comes through the door payment for services should be top of mind. All copayments and deductibles collected and any other non-covered expenses billable to the patient. The correct information is gathered and if all is handled initially properly within in the cycle the claim can go the workflow and payment received with minimum effort by human hands.

In the past the responsibility of the chargemaster, also called Charge Description Master (CDM), was assigned to a particular individual i.e. finance or business office. This department would be responsible for reviewing the CDM annually and ensuring any changes are made due to HCPCS or CPT updates, new services added, or charge increases. At times the CDM analyst would need to call upon clinical department managers for assistance with updates. Most of the time, changes were made without any input. Not involving other departments on the input of changes to the CDM leaves a hospital

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

Charge entry is one of the key areas in medical billing. In the medical billing charge entry process, created patient accounts are assigned with the appropriate $ value as per the coding and appropriate fee schedule. The charges entered will determine the reimbursements for physician's service. In this area, the electronic form 1500 is completed with its codes of services and procedures.

Medical billing translates a healthcare service into a billing claim. The medical biller makes appointments, transactions, and follows the claim to ensure the practice receives.

Revenue determination is an important tool for health care organizations because it allows for efficient management of payment systems. This paper will look at the different components that form the payment-determination bases of revenue determination. Moreover, the difference between specific and bundled service payments will be discussed. Lastly, the three ways health care providers control their revenue function will be highlighted.

Maintenance of the charge master is best accomplished by representatives from health information management, clinical services, finance, the business office or patient financial services, compliance, and information system. An inaccurate chargemaster adversely affects the facility reimbursement, compliance, and data quality; negative effects of inaccurate chargemaster include overpayment, underpayment, undercharge for delivery of healthcare services, claims rejections, and fines or penalties. The chargemaster automatically bills for numerous services for high volumes of patients without human intervention. Therefore, a single error on the chargemaster could result in multiple errors before it is identified and corrected, which results in a severe financial impact (Sayles, 2013, p.

A medical officer while taking data does them through billing in most of the occasions. The medical officer or the physician should use a universal billing form and also the global facility form on this occasion. The preferred form by the medics, in this case, is the AICPA and for the universal billing is from 1500. It is advantageous in that all patients can use it especially for the outpatient ones (Greene & Martel, 2012).

In this system, when payers pay billed charges, they pay according to a rate schedule, called a charge master, established by the provider. To a many extent, this reimbursement system places payers at the mercy of providers, especially in markets where competition is limited. In the very early days of health insurance, all payers reimbursed providers on the basis of charges. At prssent the trend is shifting toward other, less generous reimbursement methods, and the only payers expected to pay the full amount of charges are self-pay (private-pay)

The CMS-1500 form was developed by the center for medical and Medicaid service (CMS) to facilities the process of billing by easily arranging diagnoses and service providers that were necessary to treat the patient, the upper from consist in 13 form locators that contain 11data element. And the lower portion of the form consist of 20 form locator numbered 14 through 33, which contain 19 data elements, and one signature for locators.

These are all important to follow to make sure that proper reimbursement is achieved. Coding has to do with documenting the correct information when it comes to procedures and or products. Coverage is one of the most important things when it comes to the facility and the patient. This determines what the patient and facility will be responsible for in the end. Medicare is one of the biggest and most powerful payment entities when it comes to the type of coverage. If Medicare does not cover a new technology, it is very rare that any other insurance company will cover it. Medicare is so important, that private payers will follow their lead in developing their own policies. Payment is typically not collected until products have proper coding, this eliminates anyone getting over charged for a product and or service. Having a solid reimbursement strategy is extremely important to the success of new and existing technology within the healthcare field. Coding, Coverage, and Payment all need to be followed in this order to ensure that reimbursement is successful for the company and

As the healthcare industry begins to expand its horizons, by featuring more staff and patients, the types of frauds that are committed also rise in number and complexity. One of the many consequences that derives from fraud within the healthcare system includes an increase in the cost of healthcare itself. In order to limit and analyze fraud that encompasses the entirety of the healthcare industry, it is necessary to assess the different types of frauds and in doing so also understand the method of reimbursement involving the professionals and members of the health care industry. Since a majority of these reimbursements are paid by insurances or through government programs, a program known as coding was created in order to organize and properly pay off these reimbursements(Marilyn Price, Donna Norris, 2009). One of the many

First of all, medical billing is a process of submitting claims to insurance companies in order for health care provider to receive payment for service. Medical biller is the person that deals with claims. There are two different