The Healthcare Industry : A Hospital, Practicing Medicine And Medical Billing

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

Universities stemmed some of the biggest medical advances in the health care industry amongst the world. The educational platform for the United States spells long term success for health care, by growing the next generation of top health care providers. In comparison Germany and Canada also are represented amongst the top 50 medical schools in the world, but lack any representation of the top 10 prestige rankings. On top of that, both other countries lack volume and opportunity to receive a valued medical education when compared to the United States.

Continuous and life-long learning- Unlike other professions in healthcare field one has to keep in pace with the updates going on, know the new technology,

The hospital charge description master (CDM) or “Chargemaster” is extensive, containing separate and specific charge items and procedures for all departments providing patient services. In order perform a comprehensive hospital (CDM) for every item that is chargeable to be accurate, for hospital services and procedures.

The process for medical billing involves a health care provider submitting, and following up on claims with health insurance companies in order to receive payment for services rendered; such as treatments and investigations. Once the procedure and diagnosis codes are determined, the medical biller will transmit the claim to the insurance company. Most physicians have medical directors that review claims for patient eligibility. Physician reimbursement and the coding to support it are critically important to the sustained health of any physicians practice. Under the contract provisions the physicians are responsible for rendering the services to the patients. In the billing process physicians need to know how services are rendered.

Data then flows into two functions: (1) the medical documentation, which becomes the basis for clinical decision making and goes into the medical record; and (2) the charge capture or entry, where the manual “charge slips” or automated direct order entry are priced in accordance with the price list referred to as Charge Master, also called Charge Description Master (CDM). Thereafter, data from both Medical Record and Charge master flow right into the billing system. Then, claims preparation follows by filling up of either of the two types of forms: (1) UB-04, which is used by hospitals for inpatient and outpatient service claims, or (2) CMS-1500, which is used by Physicians for professional claims. These forms are then carefully reviewed in the claims editing process to ensure there is enough information to warrant payment by the payer, and logical standards are complete and well documented. (Claims Editing is not conducted by all health care facilities, but is a critical effort to secure accurate and timely payment by payers). Finally, the claims are submitted to the payers.

In the medical billing revenue cycle, there are ten steps. The first step is patient preregistration where a patient schedules a visit and their insurance is either verified or on file. The second step is to determine the patient’s payment when visiting the provider and the reason for their visit. Next is to check the patient in upon arrival at their visit. This is to verify the insurance and the identity of the patient. The patient is checked out after seeing the provider and charges for services will show on the superbill. After this, the medical biller takes the patient’s superbill and creates a claim. From here, the biller must ensure that the claim is compliant with coding and arrangement. From here, the claim is prepared and finally

Health care is a very complicated topic, when discussing the coding system used to reimburse physicians for their health services to the needs of the patients, especially those who are discussed in Rebecca’s talk. In the world we live in today, not many people have full health care coverage, let alone affording the medicine that may be needed and food or rent for their homes. “Health Leads is a simple model where doctors and nurse can prescribes nutritious food, heat in the winter and other basic resources for their patients the same way they would prescribe medicine.”(Rebecca). With Health Leads, the patients are able to take their prescriptions to their desk in the clinic, where the workers work side by side with the patient to give the best services possible and to keep patients healthy. There is a three step process in Medicare for physician reimbursement. “1). Appropriate coding of the service provided by utilizing current procedural terminology; 2). Appropriate coding of the diagnosis using ICD-9 code; and 3). The Centers for Medicare and Medicaid services determination of the appropriate fee based on the resources-based relative value scale.” (Ochsner). Based on the way that Rebecca explains the Health Leads process, it does not seem as complex or as detailed as it

“Unfortunately, when a practice takes on the responsibility of billing patients, it also incurs the cost and risk associated with it as well—including increased overhead, late payments, collections, and increasing accounts receivables.” (Abou-Zamzam, A.) As days in accounts receivable increase for a patient responsibility the unlikeliness of the patient paying the facility increases as well. This ultimately causes BRRH responsible for paying for the bill which will hurt all conflicting financials for the

A charge master typically is a file utilized by a large number of providers nationwide for creating patient charges including the outpatient services and supplies. The primary purpose of a charge master is to ensure accuracy of the patients’ records and analysis of services provided and the billing information. The Charge Master is unique in that it can directly impact the financial performance and efficiency of the hospital. Every healthcare facility, for the most part, has its own charge master to make the charge capture and billing process easier and efficiently. According to Malm (2016), a charge master consists of five essential components:

The medical billing procedure is not embraced by a solitary person. Medical coding includes front office managers, for example, receptionists, and additionally back office staff, including the medical biller and coder. It is critical to see each progression of this procedure on the off chance that you plan to seek after a profession in medical billing and coding. For the reasons our company will be maintaining the end-to-end procedure of medicinal billing overall, and not only the obligations of the biller and coder.

There was a time not so long ago when a doctor would make house calls and had a modest private practice. People did not have to worry about calculating the medical costs as the doctor would only charge what he knew someone could afford and would allow payment arrangements to be made. With this type of service, the doctor was more concerned with the quality of care provided as opposed to just getting the patients in and out.

The healthcare sector is an overpopulated industry which increases the competition among providers. There are numerous areas of concern such as patient safety and satisfaction along with an optimal work environment for staff. Organizations who retain employees who display bad behavior is implying that their aim is not on quality care and safe workplace. It’s vital to have policies in place with the consequences to guarantee that the staff is working towards the objective of the company’s goals. Leaders and managers must stay abreast of employee conducts and provide corrective measures when appropriate. BNH has to begin the recruitment process now to replace the staff that was in violation of the company’s rules. The nursing home aims to provide

Climate Change. Insurers are central to how we deal, or don’t deal, with climate change. They price the risk facing property owners, and others, from weather events. These companies could become financially vulnerable if they fail to properly account for the risks they face from climate change since it is about a $23 million global investment. Damage claims could rise significantly when the atmosphere warms up due to the retention of moisture, which can cause more extreme weather, such as more powerful hurricanes and increased flooding. Damages to this extent could create massive liabilities.

Under payment, an ideal healthcare system will have the challenge of delivering higher quality for lower costs. The system’s payment reform will involve a transition from fee-for-service to global from systems that are value-based important for the achievement of the overall healthcare goals. An ideal healthcare payment system will give a great deal of support to value-driven system of healthcare delivery (Kent, 2013). The fee-for-service payment system will be of great importance to the healthcare system as it will help control the costs of health care.