Introduction
The process of managing patient information and billing in a health care facility is made intricate by the presence of a large variety of reimbursement options present for the services patients receive. Health care providers are supposed to make sure that the charges of the bill correspond to the services provided to the patients (LaTour et al., 2013). Therefore, to maintain profitability, health care administrators are should encourage an increase in reimbursements. However, the payment method should engage the patients to make sure that their obligations are maintained (LaTour et al., 2013). The medical facilities need to support their claims to avoid cases of unpaid or reduced payments. Health information management professionals need to have a proper plan of handling reimbursement claims from their patients. Health facilities should have policies that promote active and transparent communication between the patient, the health service providers, and third parties like insurance firms.
Patient Billing
It is the responsibility of every health facility to make sure that the patients know about the costs for the services they provide and the options of payments available. With this information, the patients will be committed to meet the obligation of paying the health service provider (Kate, 2017). As such, the staff of the Revenue Management and Integrity Department at Spinning Store Hospital needs to adhere to the policy that every patient should receive a bill for services provided to the individual, followed by an explanation regardless of the mode of payment. On top of this, every patient without an insurance plan should pay cash for the services and any copayments, deductibles, and other services considered unreasonable or unnecessary by the insurance provider.
All workers in Spinning Store Hospital should document the plan of care, patients between the plan of care, treatment charts, and a clinical report when a patient is discharged from the hospital. The staff of Spinning Store Hospital should apply proper coding and billing as per a patient’s medical state and the services provided to the patient. The policy gives the Revenue Management and Integrity Department authority to question the ones responsible for the bills in case some additional information is needed. This allows the billing process to be fair to both patients and the health service provider.
It is the responsibility of Spinning Store Hospital management to make sure that all employees follow the standard regulations in the coding and billing process. Thus, Revenue Management and Integrity Department retain the authority to take action against any staff who fails to safeguard the privacy and security requirements when dealing with a patient’s information. Patients also have a right to demand an explanation of the records that Spinning Store Hospital has about their medical history.
The billing and coding policy require that patients take time first to clarify whether they are insured or not. This allows the hospital to communicate with the payers responsible for the bills in case of any emerging issue. Spinning Store Hospital could use computer-assisted coding to improve the accuracy and efficiency of the billing system, and the medical information will be store correctly for future use, in case of a claim regarding payments (Erica et al., 2018).
Claims Processing and Denial Management
Health care insurance companies have policies that monitor the payments to claims that they find appropriate. Insurance firms decide whether the inappropriate claims are supposed to be underpaid or not paid at all. Therefore, health care providers should have policies that review the claim denials and propose a way forward for the firm. The process of appealing for a claim is complicated because it requires experts who access the claim and decide on the best way to respond to the denied claim (AHIMA's HIM Body of Knowledge). Therefore, the Spinning Store Hospital should adopt the policy stating, “all healthcare providers in Spinning Store Hospital should work together to ensure that they provide the best treatment for the patients in the most cost-effective treatments available. Thereby producing high-quality health outcomes.”
Focusing on providing improved services at a reduced cost ensures that health service providers tie their work on quality and efficiency metrics, thus providing good health outcomes to the patients. The interaction between the patient and the health service provider is an essential factor in making sure that a payer will pay for the services provided without having to make a claim. The policy will motivate health service providers in Spinning Store Hospital to focus on improving their service, and in return, the patient-provider relationship will improve.
Because the policy ensures efficient and effective care to the patients, it will encourage the patients to take responsibility for their part of the deal, which is paying for the service provided. Proper integration of payments and providing medical services ensure that patients are satisfied with the service provided. Providing optimal levels of medical attention to patients not only helps to manage claims but also allows the Revenue Management and Integrity Department to focus on other ways of improving the profitability of Spinning Store Hospital.
Patient Collections
Health facilities are faced with the challenge of collecting revenue, yet the costs of labor and the need to purchase more technological equipment increases as technology advances (Martinez, et al., 2018) Insured patients cover their bills faster than individual patients. The price of claiming the unpaid amounts is high, yet in some cases, the process is unsuccessful, and the money has to be written off as bad debt. Therefore, to manage patient collections, the Revenue Management and Integrity Department should educate their staff about the need to inform the patients about their financial obligation before the patients receive medical care. It is the responsibility of the hospital’s staff and service providers to discuss the collections at the point of service. The patient should be given information on the co-payments, deductibles and other services that are not covered by the insurance company.
Patients are less likely to pay for the services received in a health facility after the treatment has been completed. Therefore, when health service providers inform patients of their financial obligation before the patients receive the service, not only will the overall revenue of Spinning Store Hospital will increase but also the accounts receivable of the hospital will reduce significantly (Parallon, 2018). When patients are given relevant information about the collections, they will be able to make arrangements on the best ways for them to make payments. The health service provider should also make sure that the patient is well informed on the copayments and deductibles that insurance firms will not cover.
The Revenue Management and Integrity Department in Spinning Store Hospital can use the aging accounts receivable data to access the financial power of their patients. The aging accounts receivables will help the health facility know if the patient collections are slowing down because of unsettled patient collections (Colleen et al., 2020). The data will also help the revenue management department in identifying patients who have not cleared their debts and estimating the amount of money to write off as bad debt.
Conclusion
The presence of managing patient information is sophisticated because of many reimbursement options. Health care facilities should make sure that they educate patients on the billing process before administering treatment to increase their revenues. They should also make sure that their billing processes are transparent. Proper communication between the service provider and the payer is also very essential. Health facilities should focus on providing quality services to the patients as a way of reducing claims and denial.
