HCM-345 2-1 Short Paper
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School
Southern New Hampshire University *
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Course
345
Subject
Health Science
Date
Jun 10, 2024
Type
docx
Pages
3
Uploaded by MasterCrownRook6
Oshea Penn
HCM-345
Short Paper
March 12,2022
Compliance, Coding, and Reimbursement
Healthcare organizations must adhere to all rules and regulations when it comes to properly billing and coding patients’ charts. Healthcare organizations are set at a higher standard than other businesses especially when it comes to being reimbursed. You can find the standards in the medical billing and coding section of the reimbursement process. If the reimbursement process is not followed this could lead to providers and healthcare organizations not being reimbursed for services that they performed. If providers and organizations are keeping up with compliance regarding properly documenting, coding, and billing then this will make the claim and reimbursement process run smoothly and efficiently. When it comes to the revenue cycle each department has a major impact to help drive the reimbursement process. It first starts with the registration department; this department must make
sure that all patient demographics are correct and that we have the most up to date insurance information for the patient. The registration department must also make sure that the patient is coming in for the correct procedure and that the correct diagnosis is on file for patient. Registration is one of the most important roles in the revenue cycle because if information is not accurately put in or confirmed this leads to a pause in patient care. Next, after the patient has checked in for an appointment or procedure, they will be asked to sign forms consenting to treatment, after the visit the patients’ medical report is sent to the medical coder. The coder will
then translate the medical report into a medical code. Once this process is done it is then turned into a “superbill” this bill contains all the information about the patient and services rendered during their appointment. The superbill is then sent off to the medical biller and creates the medical claim, which they then submit either electronically or into a paper claim. “Billers must also ensure that the bill meets the standards of billing compliance. Billers typically must follow guidelines laid out by the Health Insurance Portability and Accountability Act (HIPAA) and the Office of the Inspector General (OIG)” (Writers, 2019). The claims then need to be transmitted and sent to the insurance companies. Once the claim has reached the payer it must go through the
process called “adjudication”. This just means that the payer will review the claim and make sure
that all the information is accurate. Once this is processed and sent back to the biller it is then made into a billing statement, once the statement is created it, it is sent to the patient and the billing department ensure that patient pays or sets up a payment arrangement for services rendered.
References:
Writers, S. (2019, September 6). The medical billing process
. MedicalBillingandCoding.org. Retrieved March 13, 2022, from https://www.medicalbillingandcoding.org/billing-process/
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