SNHU Healthcare Reimbursement

As a biller or coder, if it is not documented, it didn't happen that needs to follow to be able to give an excellent service to every patients. Documentation is the key to have an appropriate health patients result including demographics, health issues, and billing. “Consistent and complete documentation in the medical record for every patient is an essential component of providing quality patient care. This documentation is required to record pertinent facts, observations and findings, and must meet certain compliance standards.” If not documented that is not necessary to give any further diagnosis

We’ve all heard the saying, “If it’s not documented, it didn’t happen.” While it is an age old saying, it reveals one of the biggest issues within healthcare. The issue is not just proper and accurate documentation, but having a documentation that can keep up with the rapidly shifting and changing landscape that is healthcare. “Documentation is critical for patient care, not only because it validates the care that was provided, but also because it shares key data with subsequent caregivers and optimizes claims processing.” (Recognizing the Value of Clinical Documentation Improvement, 2014).

At my last job working at a dermatology office, I witnessed many communication errors between staff members and patients which ultimately impacted the quality& safety of care delivered. One major incident that occurred was a patient had biopsy results misplaced. The medical assistant duties for biopsies included documentation for the patients’ chart, filling out the appropriate paperwork which was sent to a lab facility with the biopsy (either Quest diagnostics or Labcorp) and then documenting the patient’s name, date and location of biopsy in an excel spreadsheet. The office was still doing paper charting at the time so after the appropriate documentation was notated, then the charts were organized into two files, one side contained charts of those who had recent biopsies done (not pending results yet) and the other side contained charts whose

Documentation in the medical field is a vital component to providing quality care and maintaining a consistent care plan. There must be policies in place to protect proper documentation to maintain a high standard of care for patients. Documentation allows for a detailed history of care and displays methods that were successful to better direct the care plan of patients. Documentation provides structure for care plans, hospital policies are care plans for units to maintain order and provide structure for efficiency and high functionality. To maintain an optimally functioning unit there must be proper documentation for each patient, as well as policies that are enforced to keep documentation consistent,

A Hospital charge master is a computerized system used in hospitals to record services and the inventory as well as items used thoughout the hospital. They are designed to capture charges for patients accounts and billing services.The coding system is used to provide descriptions of procedure, services and items provided. They are in numeric and aplhanumeric form to translate all medical services. Reiumbursement is the amount paid to the hospital for sevices redered by patients and the third party payers. Patient registration is usually one of the first parts a patient must do before services are provided, it included all patients background and important information. It is very important because it is needed before the hospital charge master

The data flow of a patients account starts as soon as they report to a facility for any illness. This system is very important and there are many steps involved in order to maintain the patients’ data flow correctly. Any deviation from the data flow will interrupt this process and can cause many problems. It can have an impact on the patients care and disrupt the entire data flow all the way to the final billing process. As soon as a patient arrives for medical treatment their patient account is created; this starts the data flow cycle. In order to create a patients account a lot of information must be obtained, this includes their demographic information, insurance information and their medical information. Once this information is obtained and entered into the HIM system it allows all of the various departments’ to access the information that they need to make sure that the patient receives efficient treatment. Therefore, by setting up the patients account; the start of the data flow system begins and is updated every time the patient receives any form of medical care, testing, surgeries, and any other medical treatment. As the data flow is entered all information pertaining to the patient is captured within the HIM system; this is called charge capturing and this information will be used

As part of the Patient Financial Services (PFS) department, a student intern was assigned to me to assist in my task. When asked by my student intern to explain what the main function of the PFS department is my response would be that the department which is commonly also known as Patient Accounts or the Business Office. Is responsible for recording patient transactions, such as charges, payments, adjustments, and write-offs. The PFS also prepares insurance claim forms and patient statements depending on the circumstances. Not only do we process and handle the financial end for the hospital. Most importantly we have to be able to understand and be able to resolve billing issues in order to assist patients should they encounter any questions

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

Proper patient record documentation is essential to ensuring patient care by detailing the treatments the patient received, this offers a complete picture that other health professionals can use to provide optimal medical care. This record is also used as a determinant of reimbursement to the facility. Accurate documentation is the responsibility of the nurse and is a requirement of the institution the nurse is employed at. Taking the time to complete the record accurately and thoroughly is just as important as taking care of the patient. Conversely, neglecting the patient record can prove disastrous in the form of malpractice suits and jeopardizes the hospital and risks revocation of professional licensure.

As a Supervisor of a Health Information Management department within a large health care organization, one of my responsibilities is overseeing the corrections of chart errors made by providers and authors. These corrections encompass both clinical and non-clinical charting errors. I do applaud the strong emphasis placed on patient safety and the prevention of medical errors; however, patient safety does not stop with the completion of the patient 's clinical care, it should also be defined by accurate and correct documentation of patient care. If it is not documented, it didn 't happen. The best clinical care is negated by poor and erroneous chart documentation. Common examples are documenting on the incorrect patient, incorrect dates of birth, spelling/comprehension errors, copy and paste errors, erroneous patient registration errors, etc.) Therefore striving for excellent clinical care should be intertwined with correct documentation of the patient 's care.

For unknown reasons, patients were eligible for treatment in the current week, but would be out of coverage for the following three weeks for the month. This circumstance created several serious issues, firstly, it delayed the distribution of payments to treatments centers and transportation providers. Secondly, transportation providers were not receiving their full amount for which they billed, and also depending on the size of the transportation provider, ambulatory drivers were sometimes not paid for weeks. Factoring other major company expenses such as insurance, vehicle maintenance, and safety; other prominent reasons for the change was because there were no automated recording of patient eligibility, and the lack of a computerized recording system that would record the days of treatment of a patient on the part of transportation providers. Henceforth, a change needed to be made speedily to rectify the the impending issue.

This report puts forwards the justification for consolidating all the medical receipting and payments processing into the core medical system, to improve the efficiency of operations and eliminate most of the manual related processes in the current scenario. The Actisure Medical system already has the accounting functionalities within itself, thus it will be beneficial to utilize these functions and eventually improve

New stories often focus on medical billing mistakes that significantly harm the patient, yet they never publicize the stories where the medical provider loses money due to a mistake of this type. Sadly, this happens more than many individuals realize. Anyone responsible for billing in a medical practice needs to be aware of these mistakes and how to avoid them, so the focus of the practice can remain where it belongs-on high quality patient care.

The hospital tends to have data systems for data collection and commentary, the workers who are used to gathering registration and admissions information, and an organizational culture that is familiar with the tools of value improvement, they are comparatively well positioned to collect patients ' demographic information. The recommendations for enhancements the basics included in the plan of audit trails and data quality monitoring plans within the hospital are,

The medical system is trying to reduce errors through creating medical conglomerates that are associated with a specific hospital or medical school. Although all physicians’ notes are recorded into one unified medical file, which can be read by any credentialed medical practitioner in the system, mistakes are still made. There is not enough time when office visits are time-limited by insurance companies.