ipl-logo

Clinical Staff's Role In The Reimbursement Process

567 Words3 Pages

When a patient visits the hospital the clinical staff works together with the business staff to ensure that their stay is as comfortable as it can be. The clinical staff performs the medical treatments and procedures. The business staff has a process that they follow to ensure that all services get documented and reimbursed. When the patient walks into the hospital the flow of data begins. The patient account contains medical, demographic and insurance information that is used throughout the various functions to provide satisfactory care and submit charges for the services that were provided. The data flow is created to ensure that the necessary data is available to all personnel in order to perform a variety of functions. Then you have the charge-capture process which is critical to any healthcare facility. Charge-capture is the automation of the patient’s account, which means gathering all the information used for claim documentation including account information, orders submitted and services rendered. The relationship between patient accounts, data flow and charge-capture all come together in order to provide competent medical billing services in a timely manner which will maximize the reimbursement process. …show more content…

The HIM department is responsible for organization and maintenance of the computerized inventory and record system of the hospital. This record system is commonly referred to as the Charge Description Master (CDM). Reviews are conducted on the CDM to ensure that the codes correspond to the services and inventory items. They will also review the medical records for coding and clinical data to ensure the proper assignment. The role of the HIM department could ultimately increase efficiency and improve the outcome of the patients’

Show More
Related
213 Words | 1 Pages

Kaiser Permanente has been equipped since 2007 with Health Connect; which is the largest private electronic health record implementation in the world. This is a highly sophisticated electronic program that integrates inpatient, outpatient, and clinic medical records with appointments, registration, pharmacy, and billing for all kaiser members. In addition, this electronic program includes an entire medical library with a whole set of care support tools which are accessible to doctors, nursing staff and patients (Kaiser Permanente, n.d.). At kaiser permanente; nurses are expected to print out “the after-visit summary” (AVS), which contain the doctor recommendations for each patient that we see.

Read More
342 Words | 2 Pages

Patient accounts and data flow are important because this is the point where this important information is acquired by the patient. The charge capture gathers information from the patients account with the patients care services provided by the order the physician

Read More
983 Words | 4 Pages

The real-world business situation that I will be addressing by collecting and analyzing a set of data is that of a Hospital, specifically that of the hospital staff and the patient safety interaction. I have chosen this specific business as it is my hope to utilize this degree to become a director at a local hospital. In Hospital’s there are so many aspects that one needs to look at. These aspects can be broken down into individual pieces of data that can be analyzed and provide a clear outlook of change.

Read More
65 Words | 1 Pages

1. To make sure the care and treatment can continue to be given safely no matter which staff are on duty, 24 hours a day, seven days a week 2. To record the care that has been given to the patient/client 3. To make sure there is an accurate record to be used as ‘evidence’ when there is a complaint from a patient/client about the

Read More
90 Words | 1 Pages

Did you realize that as per the Agency for Healthcare Research and Quality around 700,000 to1 million patients fall in hospitals each year. 11,000 of these falls result in death. This increases hospital costs to more than $14,000 extra dollars and the patient’s length of stay is increased by an extra 6 days. This is considered a hospital acquired condition. Medicare and Medicaid do not reimburse hospitals for this!

Read More
1369 Words | 6 Pages

is a privately run home healthcare agency. Our company is operating in several locations in ten states, to date with over 40 agencies. We take confidentiality very seriously throughout all the departments of the company, making sure that the staff is aware of the policies and procedures that are put in place for assurance of our patients’ privacy. As I stated in my previous homework assignment, there are several departments within AngMar that handle different aspects of the healthcare process having the possibility of seeing patient information and there are compliance procedures set in place that are mandated by the company and the state in order to prevent any employees from sharing anyone’s private information. We work closely with Medicare and Medicaid in order to serve our patients, who are usually under a physician’s plan of care and need skilled nurses to assist them in their home (About Us, n.d.).

Read More
799 Words | 4 Pages

The data from these forms are then translated into the electronic format. Within this form there are 33 numbered fields. Fields 1- 13 are the patient’s personal informationand the insurance information fields. Fields 14- 20 are related to the patient’s medical situation (s) including dates of situations and any hospital, lab, occupational injuries, etc. Fields 21- 24 identifies the various codes for diagnostic, procedures, and services.

Read More
783 Words | 4 Pages

The medical and clinical administrator’s role would be to support service providers by offering a good quality of care and safe working practices. Administrators are often approached to provide information. Information must not be passed onto a third party unless the service user has given written consent. However, the service user can ask for access to medical documents and reports under the Access to Medical Records Act 1988 and Access to Health Records Act 1990. Medical and clinical administrators must be accommodating and refer the service user to the appropriate resource.

Read More
819 Words | 4 Pages

The authors also showed how HCPCS codes are used when healthcare providers provides education to the patient and/or their family. Gatlin, Mburu, Jackson, and Hunt briefly discuss International Classification of Disease 10th edition (ICD-10) and how healthcare providers have to adopt to a completely new alphanumeric language. In conclusion, Gaitlin, Mburu, Jackson, and Hunt has thoroughly discuss HCPCS and how important it is in healthcare billing. The authors provided two examples on HCPCS and CPT codes are used to help ensure accurate documentation for billing.

Read More
728 Words | 3 Pages

With medical billing being so important for most medical practices and facilities, accuracy is critical. Insurance companies quickly deny claims that include inconsistent, inaccurate data, and that can cost a medical practice in additional man hours and lost revenue. Making sure accuracy is a key component throughout the billing process keeps claim denial to a minimum. Let 's break it down a bit Pre-registration When the patient walks through the doors, that is when billing process begins.

Read More
588 Words | 3 Pages

Medical information is gathered and stored in a medical record for documentation purposes which is needed at the time for billing to the payer. Medical Records contain information required by The Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA requires “two categories of information be reported to payers: diagnosis codes and procedure codes”. (Cleverley, Song, Cleverley, 2011, pg. 17). There are two coding systems used to provide the required codes: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Healthcare Common Procedure Coding System (HCPCS).

Read More
1204 Words | 5 Pages

We begin each new relationship by evaluating call volumes for our clients, and assigning billing staff based on our formula for optimum service levels. Call volume and staff allocation are re-evaluated quarterly, and updated as necessary. This has proven not only successful in DM Medical servicing our clients with consistent quality, expeditious claim filing and appeals, but also ensures that our client’s accounts have the dedicated staff that their services warrants, and deserves. Management will then set a cash benchmark or cash projection for the client. This projection is based on Payer Mix, City resident demographics, call volume, and trip level of care.

Read More
410 Words | 2 Pages

As compassionate organized individuals, they are involved in providing hands-on patient care as well as efficient office management, which entail tasks such as: • Assisting with minor surgeries • Evaluating vital signs and measuring patient's height and weight • Performing basic laboratory tests • Removing stitches and changing dressings • Scheduling

Read More
257 Words | 2 Pages

Observations made demonstrated how patient experience within the department is affected by the environment in which patients are cared for including the cleanliness, the security and how well managed the department is; the interactions that occur involving compassion, being listened to and being treated with dignity and respect. The author has recognises that the environment can provide patients with a visualisation of the organisation values. The observations made have reaffirmed that patient experience is an equal element in achieving high quality care. The author acknowledges that the experience may have been different if the activity was undertaken at a different time e.g. not in the school holiday period or later in the morning which

Read More
775 Words | 4 Pages

The focus on genuine care and interaction between patient and healthcare worker is the very basis of a healing hospital. The first component of a healing hospital is an environment that promotes healing; this includes comforting hospital aesthetics and promoting and relaxing environment that does not induce stress in the patient. By designing the hospital in a way that promotes comfort it eases the patient 's mind and allows them to fully rest. The second aspect of a healing hospital is the integration of work and technology. Technology is a tool that makes treatment and diagnosis easier on the healthcare workers.

Read More

More about Clinical Staff's Role In The Reimbursement Process

Related Topics

Open Document