Clinical Staff's Role In The Reimbursement Process

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.

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’