Prompt billing system The choice provider for a business should be happy with the client. For that to happen, the structure of payment should be an excellent one. Prompt services rely on the medical billing system that the medical insurance provider has. A good medical billing system keeps good records of client information such that the healthcare provider and the medical insurance company have information on the client such that none feels that the one has acted unfairly. The employee who works in the medical billing system should be well trained and should cherish honestly. They should also be people who pay attention to detail and have analytical eyes that can detect trends. They should also be sociable and competent to answer questions
When talking about healthcare systems there are a few factors that we should consider essential in defining the experience; Personal payment, choice of doctor and freedom of practice
A certified medical biller is one who passes the Certified Medical Reimbursement Specialist Exam and because of the certification, they are greatly sought after. Medical billing presents the chance for a well-organized, task-oriented individual to use her eye for specificity in a crucial role within the health care industry. A biller with a good sense of self-concept can communicate effectively because they are confident in themselves, they can accurately rea...
Employees are often your first and last points of contact for patients. Creating the opportunity to empower your employees to provide exceptional service is key. Proper training, and placing the tools in your employees hands to “wow” your customers, enables you front-line to be more efficient with issue resolution.
Langenbrunner, J., Cashin, C. & Dougherty, S. (2009). Designing and implementing health care provider payment systems how-to manuals. Washington, D.C: World Bank.
They play a major role in health care field. Their goal is to make all patients feel a friendly and welcome environment therefore, they greet and welcome patients so that the facility builds a good reputation in patients. Medical receptionists perform professional duties from the front desk that way they can interact with several patients, make several phone calls, answer patient questions within the scope of their practice, schedule new and follow-up appointments, register all new incoming patients and update records if necessary (Lisa Davila, 2010). The receptionist should know how to interact and treat people with different personalities and in different circumstances (Lisa Davila, 2010). Medical receptionists work
Making sure that they give each of the patients the best possible customer service helps the hospital to run at a decent rate as they will be more likely to help them when they see what is wrong with them. This is important as they need to try and keep everyone happy within the bed and the ones that go to A&E as well.
Managed care, as it relates to providers healthcare, can be defined as a patient that only sees the doctors and specialists that are in their health plan. In compliance to this agreement, the co pays are lowered by a managing company who oversees all health care interactions of their clients. The reason these costs are kept significantly lowers is because the company has contracts with particular healthcare providers and hospitals. There are three different types of managed care plans that are available. These are Heal Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Point of Service plans (POS). Each is a little different from the other, but provide the same basic service, managed health care.
Medicare part A payment reimbursement is done through a Prospective payment system (PPS). Under the PPS Medicare payment is based on a predetermined, fixed amount. In order to determine the payment amount for a particular service different classification systems are used based on setting type 6. In fact, Centers for Medicare & Medicaid services (CMS) use separate PPSs all together for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities 6. Since implementation of the PPS to each of these settings, healthcare providers (i.e. Physical Therapists) have faced many challenges.
Healthcare is considered of one of the most complex business models in the American Industry because it is one of the only industries where the consumer actually does not technically pay for the service he or she receives (Kudyba, 2010, p. 2). When consumers go to nail salons or hair salons, he or she pays the beautician for the specific service he or she asks for. In the healthcare industry it is totally different and most consumers do not understand the complexity of this business model. The consumer actually pays insurance companies and the insurance companies pay the provider/hospital based on negotiation arrangements from the data exchanges they receive (Kudyba, 2010, p. 2).
Healthcare professionals: Seek the beneficence and nonmaleficence of the patient by giving them truthful and accurate documented services and charging fair legal rates according to standard industry protocols that are reproducible, verifiable, and truthful for the services
Medical Coding and Billing can help doctors by handling all the paperwork that has to be submitted to the insurance companies. They can also help by sending medical bills out to all the patients that have been seen by the doctor.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
People that are interested in this line of work like activities that include leading, making decisions, and business. They have integrity, have leadership qualities, are able to take initiative, and are dependable people that can handle a high stress level. I learned from my results that I am more of social person and the interest profile would recommend me doing something that helps people or being of service to people, which I feel that I am able to do in this profession. I also was ranked highly in enterprising which means that I like persuading and leading people which I think is a great asset as well for being able to run a major facility and work with many different people this seems like these would be essential traits for this position. Further research has lead me to find a few more ideal characteristics to have. One being able to communicate clearly and respectfully with patients, customers, industry leaders, and hospital workers. Second, leadership is important. A healthcare administrator needs to have the ability to create a shared vision for and inspire the entire work staff/team. You also have to have a good knowledge of healthcare. Someone that is able to stay on top of healthcare system policies, the latest innovations in healthcare technology, and the ever changing political landscape of the industry. (Healthcareadministration.com,
Tasks performed by the physician assistant and medical students ensure that the hospital runs efficiently, but could be done by another individual on a higher level of authority. Individuals responsible for managing the hospital records are also part of the lower hierarchy. These individuals are also responsible for creating written communication between employees, ensuring a effective system of communication between employees. Taking care of medical records is another key factor that ensures that hospitals run smoothly. However, employees at this level are considered a lower level of authority due to how replaceable they are. Another key aspect to why these individuals are located on the lower level of authority is because of their lack of degrees and licenses that enable to treat
Health insurance specialists has become a very challenging career, however, provides the opportunity for advancement. Possessing the knowledge and understanding with processing claims and billing