Introduction
Healthcare reimbursement refers to plans that seek to benefit the employees after their employers make such reimbursements in their favor. In this case, such a plan differs from conventional healthcare arrangements where employers allow their employees to cover a health plan. Healthcare reimbursement issues affect the payers, the providers, and the patients at large. Although healthcare reimbursements have challenges, medical billing and coding regulations affect such arrangements in any healthcare organization.
How Medical Billing and Coding Regulations Affect Reimbursement?
Medical billing and coding regulations considerably impact the clinic or other healthcare organizations. In addition, such billings and regulations affect the reimbursement process. In this case, improper billing is usually a consequence of improper coding that leads to inaccurate results. Such inaccurate results directly influence the clinic’s or healthcare organisation’s bottom line (Kristensen et al., 2019). If healthcare personnel incorrectly down-codes a considerable procedure leading to inaccurate results, it will also lead to lower reimbursements. Medical coding plays a leading part in the revenue cycle, which requires it to be handled with extreme accuracy and diligence. When the medical coding process is not handled correctly, it can have considerable consequences on someone’s practice. When there is a case of improper billing, it becomes the responsibility of upper-level management to handle damage control (Bonawitz et al., 2020). Such billing and regulations also hinder the safety of patients as the coding system entirely depends on consistency. In this regard, even a tiny mistake, such as a minute error, leads to different diagnoses affecting the reimbursement. As a result, it delays services and denials, affecting revenues and eventually destroying patients’ experiences. Medical billing and coding can also affect the patient’s satisfaction, mainly when the services offered are not up to date.
What Healthcare Departments Do to Drive the Reimbursement Process?
The different steps in the revenue cycle include pre-registration, claim submission, patient collections, insurance follow-ups, remittance processing, charge capture, and registration. In this case, the revenue cycle begins with a hospital visit or appointment and ends when a hospital or other medical provider gets full pay for the services offered (Bonawitz et al., 2020). In any healthcare organization, revenue cycle management is an elaborate process that involves the healthcare systems following up on revenues from patients from their first encounter or appointment with their healthcare arrangement to their payment balance. Medical coding and billing are the backbones of a healthcare organization’s revenue cycle, ensuring that patients and payers reimburse providers for the services rendered. Medical coding and billing translate the encounters of patients and the languages the healthcare facilities use for claims reimbursement and submission. In this case, coding and billing are different processes, but both are vital for healthcare providers to access payments for health services (Kristensen et al., 2019). Coding entails getting billable data from clinical documentation and medical record. On the contrary, billing entails the codes that form the basis of patients’ bills and insurance claims. The process of claims involves the intersection of medical coding and billing to form the cornerstone of the revenue cycle of the healthcare system.
Conclusion
In conclusion, there are many ways medical coding and billing regulations affect reimbursement in any healthcare organization. For example, inaccurate billing and coding will lead to declining clinics’ bottom line. In addition, it will also affect the satisfaction of such patients and their safety. In a healthcare system, the revenue cycle has various steps, such as pre-registration, remittance processing, collections, follow-up, claim submission, charge capture, and registration. There are various ways that healthcare sections do to drive the process of reimbursement, such as ensuring that patients and payers reimburse providers for the services rendered.
References
Bonawitz, K., Wetmore, M., Heisler, M., Dalton, V. K., Damschroder, L. J., Forman, J., Allan, K. R., & Moniz, M. H. (2020). Champions in context: Which attributes matter for change efforts in healthcare?Implementation Science, 15(1). Web.
Kristensen, F. B., Husereau, D., Huić, M., Drummond, M., Berger, M. L., Bond, K., Augustovski, F., Booth, A., Bridges, J. F. P., Grimshaw, J., IJzerman, M. J., Jonsson, E., Ollendorf, D. A., Rüther, A., Siebert, U., Sharma, J., & Wailoo, A. (2019). Identifying the need for good practices in Health Technology Assessment: Summary of the ISPOR HTA Council Working Group Report on good practices in Hta. Value in Health, 22(1), 13–20. Web.