HCA240 Interview
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Grand Canyon University *
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240
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Medicine
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Dec 6, 2023
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docx
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Uploaded by niesha95
Biller/Benefits Coordinator Interview
Roniesha Powell
Grand Canyon University
HCA-240-0500
Joseph Anderson
October 30
th
,2022
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Interview: Biller/Benefits Coordinator
Everyone may not know that the health care billing and coding department is very complex. In this paper it will teach you just how important the department of medical billing and coding is and why it is necessary. After interviewing Samantha who works in a hospital but oversees other organizations within the area, she made it very clear of the complexity. She was asked a few questions. One of the questions that was asked was regarding what made you become interested in working in the billing department, during that time Mrs. Samantha Johnson responded, “I grew up with a love for math, I was told by everyone ear or around me that I should do something complexed and with billing and coding it fit perfectly”.
Interviewing Samantha she stated that she has been working in this field as a manager for 8 plus yea, she is responsible for gathering patient’s medical cost as well as sending off invoices to get patients payments whether from the patient or the insurance company. The interview proceeded with questions like the differences within cash payments, having a third-
party payment and Medicaid and Medicare. She also gave insight on what the differences are in the pricing process between various industries and the impact of government insurers and payers have on reimbursements.
Ms. Johnson proceeded to say that the billing process at her hospital and other organizations must be done while your head is clear and away from distractions. According to Medical Management Service (N.D) it states, medical billing plays a crucial role in practices, ensuring the revenue cycle runs smoothly. Medical billers need to be aware of various medical laws and the rules of both private and public insurance plans. They require expertise in claim management, claim follow-up, claim rejection resolution, posting payments and bill changes, and
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appeal submissions. An increase in revenue flow across the entire practice is guaranteed by effective management of these components. Billing helps us keep track of what patients came in and was charged. It also a great way for us to know how to charge the insurance company or the patient in some case it could be both if they have a co-pay. It gives the providers the time to charge for what was done in their care, give accurate data about the treatments they have received. She also stated that “With the billing process it takes time. Working and overseeing numerous organizations it gets hard to keep up. But I can say that once the patients is registered into the hospital whether it is an appointment, or they are going to the emergency department we will also need to verify your insurance, verifying insurance anywhere is pretty important, it helps
us know if you have any, if you are going to be covered by your insurance, in addition to that we make reports that are then translated into codes and sent off to the insurance company”, with the billing process it takes time. Working and overseeing numerous organizations it gets hard to keep
up. But I can say that once the patients is registered into the hospital whether it is an appointment, or they are going to the emergency department we will also need to verify your insurance, verifying insurance anywhere is pretty important, it helps us know if you have any, if you are going to be covered by your insurance, in addition to that we make reports that are then translated into codes and sent off to the insurance company. With cash payments being the glue to any organization there must be priorities to ensure that the operating is ran smoothly. For reducing the number of reimbursements that are not so forthcoming Mrs. Johnson said it is very necessary that a protocol of verification of the financial liabilities are spoken for before any patients are seen.
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In addition to paying with cash versus insurance through Medicare or Medicaid Mrs. Johnson spoke on that these are options are made clear to any patients coming to the facility. She also stated that the use of cash in her opinion is the easier way out because there would be no need to contact insurance companies about the patients with the thoughts of being denied. With that there is not a “waiting game” or hectic process. According to this article it states State- or health-plan-set base payments as well as supplemental payments are included in Medicaid hospital payments. The use of additional payments can raise Medicaid payments above costs even while standard Medicaid payments are normally below expenses (Medicaid a Significant Source of Untapped Reimbursements: Don’t Limit Insurance Discovery to Self-
Pay, 2019). Therefore, the cash option is taken by a few, mainly those who are not covered by
insurance for several reasons. Being advised that people who have higher deductibles find to be better at self-pay. Third party companies a person needs to be able to follow the requirements to send bills. Insurance providers precisely have requirements and medical bills
must meet the requirement. Medicare and Medicaid have multilayered procedures that are regulated through the government and must be looked multiple times before payments are reimbursed. With the difference in charges and prices methods Mrs. Johnson stated that “every health care providers have their own unique criteria needs to cost”. She observed contributions to healthcare costs have stretched beyond the simple cost of the used materials and the pay of the physicians. There are differences between cost, technology that has been applied and the specific
of the patients. She also stated that with outpatient billing that just means someone came in for the day and saw a doctor that works in the hospital whereas there could be a patient that stay for 4
a period of 4 to 6 days, and they are billed accordingly is called inpatient billing. Due to the complexity of healthcare pricing, it is challenging to allocate costs in order to determine the precise cost of each cost component. There have been complaints that the majority of those responsible for the US's soaring healthcare costs. Pricing is based on the dominant insurer; if one
insurer dominates in a particular area, cost may be determined by that insurer. Usually, insurance companies with a lot of customers can bargain and get a better deal. As a result, payment is dependent upon both public and private payers. The government has a specific protocol that must be followed before making a reimbursement, according to Mrs. Johnson. In most cases, before a government will pay for a service, all other parties must first pay their share, with the government covering the remaining costs in the case of people having various insurance plans (Cleverley & Cleverley, 2018). Nevertheless, the government invoices are paid, despite the fact that the government agency determines how much providers are paid. Private payers refund claims quickly and do not follow complicated processes like the government does. Payment arrangements with private parties are also the simplest. Governments are preferred by Mrs. Johnson because they are dependable and guarantee a steady supply of income, which can be advantageous to suppliers. The most fundamental and typical sort of electronic medical transaction is the health care claim. Billers submit claims to obtain payment on the providers' behalf. Claims contain codes for the treatment and diagnosis as well as details about the patient, the provider, and the patient's health insurance plan (Medical Billing & Coding
Certification, 2022).
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To conclude after having the pleasure of interviewing Samantha Johnson who oversees numerous organizations, she explained just how important the billing and coding department really is. She also gave me some advice on if a person wants to do billing and coding. She advised that “if you think about working in the billing department, I think you should be confident with numbers, the use of billing codes. I think you should be able to confidently be able to solve problems when you come across issues, it not a day that goes by where an insurance company reports back and the denied all the claims. It takes hard work, more than a person think, must always be prepared for things, even if they do go smoothly”. Working in the billing department is very complex, it can be frustrating at times but if you are a people person with a high confidence level as with any job but working in billing and coding requires that and much more.
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I had the pleasure of interviewing Samantha Johnson, who oversee numerous of facilities/ organizations in my area of Virginia. What made you interested in working in the billing department?
For me getting started working in the billing department I grew up with a love for math. I was told that I needed to be working in a field that is complex. With billing I would say the first year was very rough, after the years it gets easy, then you also must change with the laws just to be updated on everything.
What is the patient billing system With the billing process it takes time. Working and overseeing numerous organizations it gets hard to keep up. But I can say that once the patients is registered into the hospital whether it’s a appointment, or they are going to the emergency department we will also need to verify your insurance, verifying insurance anywhere is pretty important, it helps us know if you have any, if you are going to be covered by your insurance, in addition to that we make reports that are then translated into codes and sent off to the insurance company. What is something you think I should know when it comes to billing?
If you think about working in the billing department, I think you should be confident with numbers, the use of billing codes. I think you should be able to confidently be able to solve problems when you come across issues, it not a day that goes by where an insurance company reports back and the denied all the claims. It takes hard work, more than a person think, have to always be prepared for things, even if they do go smoothly. What is outpatient billing?
With outpatient billing that just means someone came in for the day and saw a doctor that works in the hospital whereas there could be a patient that stay for a period of 4 to 6 days, and they are billed accordingly is called inpatient billing. Why is billing process necessary?
Billing helps us keep track of what patients came in and was charged. It also a great way for us to
know how to charge the insurance company or the patient in some case it could be both if they have a co-pay. It gives the providers the time to charge for what was done in their care, give accurate data about the treatments they have received.
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References
Cleverley, W. O., & Cleverley, J. O. (2018). Essentials of health care finance (8th ed.).
Jones & Bartlett Learning. ISBN-13: 9781284094633
Medicaid a Significant Source of Untapped Reimbursements: Don’t Limit Insurance Discovery to Self-Pay.
(2019). Receivables Report for America’s Health Care Financial Managers, 34(4), 3–4.
Medical Management Service (N.D). ENSURING PAYMENT FLOW. Why Are Medical Billing and Coding So Important? - Medical Management Services (mybillingguy.com)
Medical Billing & Coding Certification (2022). HIPPA & BILLING.
HIPAA and Medical Billing (medicalbillingandcoding.org)
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