Running Head: HEALTHCARE e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e
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2-1 Journal: Compliance, Coding, and Reimbursement
HCM 345
SNHU
HEALTHCARE e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e
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In the healthcare setting, the billing and coding regulations have a direct and
significant impact on the reimbursement aspect. The regulations relating to billing and
coding, influence the medical codes that healthcare organizations use while ascertaining
the services that have been delivered to the patients. They ultimately shape the entire
healthcare revenue cycle by making sure that payers as well as patients make payment
for the services that have been delivered to them (2021 MedicalBillingAndCoding.org,
2019). Such regulations also ensure that the billing process is carried out smoothly and
there is proper control over errors and mistakes. Such regulations also act as vital tools
that prevent any kind of fraudulent activities relating to reimbursement for healthcare
services delivered by healthcare organizations.
A broad range of tasks have to be carried out by different healthcare departments
when it comes to the reimbursement process. The first step involves the registration of
the patient when he comes to a healthcare facility to avail healthcare services. Then the
financial responsibility of the patient is determined. At this stage it is necessary for the
biller to identify who owes what for the patient’s visit to the physician (Buck, 2016).
The insurance coverage of the patient is checked so that the bill can be correctly
assigned. The next tasks involve patient check-in and check-out which lies at the heart
of the reimbursement process. The following processes involve preparing the claims and
checking the compliance. At this stage the biller has to take the superbill of patients
from the medical coder and puts it in billing software and then the claims are
transmitted. After the claim has reached the patient, the adjudication process is
conducted where the payer checks the medical claims. After receiving the report from
the patient, the biller is responsible for reviewing it. Ultimately, patient statements are
generated by the biller which is nothing but the bill to be reimbursed.
HEALTHCARE e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e
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References
2021 MedicalBillingAndCoding.org. (2019, March 22). What is Medical Billing and
Coding?
MedicalBillingandCoding.org.https://www.medicalbillingandcoding.org/medical-
billing-coding/.
Buck, C. J. (2016). Step-by-Step Medical Coding, 2017 Edition-E-Book. Elsevier Health
Sciences.
