An increasing issue within the health care field is the inability to collect debt from the growing population of uninsured or underinsured patients. Healthcare organizations may be struggling to meet operational margins because the industry has never treated its customers like other retail-oriented sectors of the economy. A McKinsy and Company report states that hospitals incur sixty billion dollars in bad debt annually because they typically collect only ten to twenty percent of a total uninsured patient balance after service. (MacKenzie, 2009) This is due to a number of reasons, including poor accounting practices or a lack of patient information. This paper will discuss how one hospital, California’s Sutter Health, has taken steps to correct this issue. It will analyze the accounting practices put into place by Sutter Health and the success of this practice. This author will also provide an alternate solution to the issue of debt collection for self-pay patients as well as an opinion concerning the actions taken by Sutter Health.…
Refer to Figure 15.1 on p. 487 of your textbook, the Internet, and the University Library as resources. Search for medical office financial policy advice as well as sample policies.…
The compliance process is critical when it pertains to the billing and coding process. It is imperative for Medical Insurance Specialist to remain current on the patient’s participation in contract as well as the medical insurance policies, so there will not be any billing errors. Maintaining a communication with the payer will also prevent billing errors. Such regulations and laws are in place for to protect the patient’s financial state, prevent errors of billing and coding, and to link procedures and diagnoses correctly. Becoming knowledgeable of the billing rules should also help prevent billing errors as well. In this assignment, I will discuss how important it is for medical staff to be knowledgeable of the billing and coding compliance strategies.…
Evaluating a medical office's entire process, from patient check-in through patient exam and follow-up, is extremely important to establishing and maintaining an efficient system. A smooth patient check-in is essential to meeting the needs of each patient in an orderly fashion. Front-desk staff members need to initiate a patient charge for each patient. In addition to other information, the patient's insurance policy and policy number should be listed on the form, if the patient has health insurance. A copy of the patient charge sheet is then attached to each patient's medical record.…
In a medical office, a financial policy must be easily understandable to the patient when reading his or her policy. In order to provide proper answers to any patient with a question regarding the material a trained staff member should be provided to inform the patient of what the policy means. The basic elements on effective medical office financial policy are that the patient and medical staff are aware of payments, arrangements made for unpaid balances, low income sliding scale acceptable forms of payment, such as cash, checks, credit cards or money orders. “These are used to pay the covered deductibles, copayments, and discounted service for people without insurance (McGraw-Hill, 2008).”…
Keeping the staff members current with their training and up-to-date with the rules and regulations within a facility will keep the compliance plan for the medical records documentation standards…
The health care industry is a multi-million dollar industry. Health insurance, providers, technology management, and inpatient and outpatient procedures are among the many terms that we hear nowadays within this industry. The principal phrase that seems to be ringing in the ears of the government and policymakers are debt and cost-control. There are fundamental concepts that should be understood throughout the health care industry as it relates to finance. On one hand, many individuals have a general knowledge concerning health care organizations from the standpoint of insurance, copays, and deductibles. These constructs are more familiar to a person that has any health care needs due to the routine of having to provide some form of payment…
Proper, precise, and ethically sound financial management and reporting is required of all healthcare organizations. According to Wisconsin Government (1994), “agencies are required to have an effective financial management system as a condition of receiving federal funds. Federal and state rules and regulations establish several criteria that the financial systems of agencies receiving funds must meet” (Basic Elements of an Effective Financial Management System, para. 1).…
Compliance plans are put into place to find, correct, and prevent illegal medical office practices. In correlation with medical records documentation standards, these plans eliminate the possibility of errors by training staff members who work with medial records including front office staff along with billers and coders.…
The second step is to establish financial responsibility. This step takes place during the encounter. Insured patients are asked a series of questions essential to knowing to correctly bill payers for patient’s services for that visit. These questions also help medical insurance specialists ensure that patients will pay the bill when insurance does not cover some of the services. The patients are told that they are responsible for any charges not covered by the health plan. Payment options are usually available if the bill will be substantial.…
Billing coding and compliance strategies take some learning and some practice but they can be done easily with the correct knowledge. Billing compliance has some billing rules to know and it also has many steps involved to get the billing and coding cycles done. The connections between claims, files and diagnoses will be discussed in this essay. The importance of correctly linking procedures and diagnoses and implications of incorrect medical coding will also be discussed. It is also important for me to include how the billing, coding payments and physicians all link together in the compliance process.…
Understanding health care financial terms is a prerequisite for both academic and professional success. This assignment is intended to ensure you understand some of the basic terms used in this course.…
The HCS 405 week 1 financial terms worksheet throws light on some of the most basic concepts of the healthcare business. Understanding health care financial terms is a prerequisite for both academic and professional success. The health care business helps the nation by providing the building blocks that the citizens need to live a successful and healthy life. The worksheet is intended to ensure that the students understand some of the basic terms used in the business world of the health care industry. The purpose of HCS 405 individual and team assignments is to make the students aware about the numerous strategies employed in the financial and other departments of a health care sector.…
Determining the patient’s financial responsibility is the second step. To be eligible for insurance coverage doctor’s office standards must be met by the insurance provider. Patients are responsible to pay whatever percent of the bill that the insurance does not cover. If the patient does not have insurance, the patient is responsible to pay the whole bill.…
Financial Management is a fundamental part of successful healthcare financial planning. Financial decisions are a necessary part of day to day operations of any size or type of health care facility. These decisions are made in accordance with the facilities fiscal objectives and accounting practices. It is important that the individuals making these decisions follow proper reporting and ethical practices since these decisions affect the future of the entire facility. In order to make finical decisions it is important to understand generally accepted accounting principles, corporate compliance, ethics, fraud and abuse.…