Bullying and Coding in Healthcare Settings

When a patient comes in for services it is very important that the person taking the patients information make sure it is completely accurate and error-free. This personnel must be able to be personable and have good customer service skills because this is the first person that the patient comes into contact with. The data being collected from the patient will include name, date of birth, insurance card, driver's license, ect. Making sure all of his information is put into the system correctly then the hospital or establishment can get paid faster.

(Riley, 2015) There are resources that allow registrars to see if the patient is financially stable or if they need to ask for a portion of the payment now. Utilizing a patient payment predictor can indicate whether or not it is likely the patient will be able to pay. By having all of this information the patient can be called, before showing up to their appointment, and know how much they will need to pay out of pocket.

Get quality help now
RhizMan
RhizMan
checked Verified writer
star star star star 4.9 (247)

“ Rhizman is absolutely amazing at what he does . I highly recommend him if you need an assignment done ”

avatar avatar avatar
+84 relevant experts are online
Hire writer

This in return can make patients happier because it prepares them and doesn’t throw them off guard in the situation. (Riley, 2015)

Third-party policies or payers are sought out when a patient cannot make the payment on their own. “Third-party payers may be federal, state and local government programs or private health insurance companies.” (Who are third-party payers for healthcare organizations?) Third-party policies are used to make sure the hospital or health care facility is paid for the services they have provided.

Get to Know The Price Estimate For Your Paper
Topic
Number of pages
Email Invalid email

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy. We’ll occasionally send you promo and account related email

"You must agree to out terms of services and privacy policy"
Write my paper

You won’t be charged yet!

Third-party payers are agents who guarantee to cover the patient’s healthcare-related payments. (Who are third-party payers for healthcare organizations?) If the patient is in need of a third-party payer this should be taken care of before the patient shows up to the facility. It is best to help the patient seek out third-party coverage before they come in for their procedure, so that the reimbursement process is not held up. (Riley, 2015)

The key areas that need to be reviewed for getting reimbursed are registration, insurance verification, hard and soft coding, bill processing, and cash postings and collections (figure 10.1, Harrington, 2016) Registration personnel is the first point of contact for the patient. This is personnel is supposed to gather all the patient's information that will support the care they are about to receive and also support the billing for the care. Insurance verification is the next step in the registration process that needs to be done. By verifying the patient insurance the personnel will know what kind of co-pays and pre-authorization is needed for this patient. This can make a big difference in waiting times for the patient. If the patient needs a to be pre-authorized then the registration personnel can work on that before the patient arrives for their appointment which can help eliminate wait times for the patient. If the insurance verification process is not completed then many things can go wrong such is patient's claim is denied or the wrong co-pay was collected. (Harrington 2016) This is return could take up to weeks to get fixed.

Coding is the next thing that needs to be reviewed. Without the right coding for billing purposes, the claims that are processed could be denied. The codes must match up with the patient information and the procedure that was done. An example of wrongful coding would be if the patient documentation stated that the reasoning for the test was the patient has “chest pain” but the patient did not state they had chest pain they only stated they were short of breath. This would be wrongful documentation and the claim could potentially get denied. After the right coding is put in then comes claims or bill processing. This involves taking all of the patient encounters and adding them up once the patient is discharged. The time it takes to collect on claims is evidence on how the Revenue Cycle is working. If the Revenue Cycle is working effectively then there should be a quick turnaround on payment. “Payment posting is where the insurance company pays the claim that was submitted and then once the facility receives payment they can post the payment to the open accounts receivable.” (Harrington 2016) We always want the patient account to be at zero balance because that means that claim was paid and the patient owes nothing. (Harrington, 2016)

Follow-up calls to the patient should be made after they have received their services. During a follow-up call the patient should be asked how their experience was and what could’ve been done to make it better. This is a good way to see how the company is providing care and what could be improved upon. These calls should also include information about the patient's follow-up visits and medications. There should be documentation of all calls and calls attempted. All calls should be recorded for quality assurance. By recording the calls, management can than monitor whether or not everyone is doing what they are suppose to.

Having an effective compliance program is a major key to avoiding getting audited. A compliance program essentially makes sure the company is following all the rules regulated by the government. (Zabel. 2016) “The ACA has seven core elements for an effective compliance program.” (Zebel, 2016)

  1. There will first need to be a list of rules about compliance for the employees to follow.
  2. Then, a compliance officer will need to be chosen. This person would be the one that is constantly making sure everyone is following the rules and enforcing them.
  3. There should be a reporting system where employees feel they can come to make complaints about the program that need to be worked on.
  4.  Employees must attend a training program that teaches about compliance.
  5. There should be someone auditing the company just to make sure that the compliance program is working effectively.
  6.  employees fail to comply with the rules that are set, then disciplinary action should be required.
  7. When problems are identified, actions must be taken to correct them. (Zabel, 2016)

Managed care contracts are detrimental to the company’s financial stability. (Successfully Negotiating Managed Care Contracts) When trying to negotiate the company should think about what kind of pay-provider relationship they want. The major differences are going to come if the company wants a one-time deal or a long-term deal. (Successfully Negotiating Managed Care Contracts) These negotiations are to receive compensation for the services that were provided. Some strategies would be; reach out to your contracting counterpart, mine internal claims data, scrutinize denials, and survey operational staff. (Successfully Negotiating Managed Care Contracts) The people most important in regards to managed care contracts would be the personnel that makes the deal and the personnel that see that the money gets paid.

To ensure billing and coding compliance the employees should know the rules and regulations that go along with it. The personnel hired to do billing and coding should have ethical standards and know not to change any reports or documentation for coding and billing purposes. (AHIMA House of Delegates) If rules and regulations were not established and the employees didn’t know about them then they may think it is okay to change documentation for coding and billing purposes.

Updated: Dec 18, 2021
Cite this page

Bullying and Coding in Healthcare Settings. (2021, Dec 18). Retrieved from https://studymoose.com/bullying-and-coding-in-healthcare-settings-essay

Bullying and Coding in Healthcare Settings essay
Live chat  with support 24/7

👋 Hi! I’m your smart assistant Amy!

Don’t know where to start? Type your requirements and I’ll connect you to an academic expert within 3 minutes.

get help with your assignment