In replying to the postings, you are to critically evaluate all of the following for at least two main postings:
- Are the explanations of the roles of each of the five components listed above clear, complete and accurate? If not, explain.
- Is there a clear relationship between each of the five components described and the hospital billing system?
- Provide at least one addition to one of the component descriptions (identify another person, organizational component, process, data element, or aspect of technology)
Patient management can have many aspects. One of those aspects include the billing system. The billing system for a healthcare organization is a bit more extensive that what the name implies. For example; it has an impact on staff performance, and the people affected by the billing system. It also has many organizational components such as different departments and outside organizations. It includes more processes than the obvious processes as well. It includes data elements. And it is greatly benefited by the advancements in technology as well as every other aspect of healthcare.
People: There are many people involved in the billing system of a healthcare organization. Proper usage of an organization’s billing system is vital to the financial health of the organization. The people who use the organization’s billing system can vary from place to place. Staff such as administrators, doctors, nurses, medical coders, and payers such as insurance companies are the ones that deal directly with the billing system. However, many more people are affected by it. Ranging from patients to healthcare providers.
Organizational components: The organizational components of a billing system in healthcare organizations can be divided in two aspects: The front end and the back end. The front end deals in real time. It includes processes such as patient data collection, registration, scheduling, eligibility, authorization, and upfront patient collections. The back end on the other hand deals in periodic bill processing time. It includes medical coding and billing, claims management, and final patient financial responsibilities collections. The back end includes outside organizations as well such as insurance companies or government healthcare programs such as Medicare and Medicaid to just name a few.
Processes: The billing system of a healthcare organization has quite a few processes or activities that the users of the system have to be engaged in. These processes are: Patient registration, establishing financial responsibility, insurance eligibility, patient check-in, and patient check-out, medical coding and billing compliance, preparing claims, transmitting claims, payer adjudication, producing patient statements and patient bills, and arranging collections of payments
Data/Information: Some of the key data elements in the billing system include: Patient personal identifiable information, payment history including outstanding balances, insurance or payer information, compliance with HIPAA since billing information includes unique identifiable information of the patient, health history such as previous surgeries, allergies, and other medical conditions of the patient.
Technology: Without a doubt technology has made our lives easier. It could be said that it has improved just about every aspect of our lives. The healthcare billing system of a healthcare organization is no different. The digitalization of health records has made it easier for doctors and healthcare providers to access patient information from virtually anywhere. Doctors making house visits for example or having phone consultations from home and submitting the required documentation for billing. The billing system has benefited from the advances in technology greatly. It also serves as a security measure for billing information or any information for that matter in the case of having to access a back-up and resubmit claims. Moreover, technology has made so that software developers can create programs that can determine charges, claim forms, and current standing of a patient.
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