Running Head: HEALTHCARE i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i 1
2-1 Journal: Compliance, Coding, and Reimbursement
HCM 345
SNHU
July 11,2022
HEALTHCARE i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i 2
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 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i 3
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.
