The Medical Billing System and the Healthcare Manager
The healthcare administrator is responsible for all the day to day functions of a healthcare facility. This individual must ensure that the administrative side of healthcare facility runs smoothly across the myriad organs of the facility. These involve support staff, policy objectives, budgets, recruitment, as well as the clinical staff needed to provide healthcare services. One of the most essential tools that the healthcare administrator must manage is the billing system. What one may not realize is that billing systems vary widely across many different facilities depending on the population for which treatment is being provided. This complexity in billing systems can create confusion and make it difficult for the healthcare administrator to stay abreast of the advancements in their profession, especially since there are many different populations and treatment facilities, each with their own relationships to insurance providers and business models.
One of the better advancements in healthcare management has been the move away from a paper billing system to an electronic one. The growth of the healthcare industry has necessitated the use of electronic information systems that are better able to cope with the sheer volume of information that must be processed in a healthcare facility. This involves information from patients, doctors, labs, accountants, marketing, budgeting, and other administrative concerns. Primarily, the medical billing process is an interaction between a healthcare facility and the insurance company. Often it is a longterm process that requires many steps to reach a solution, either across many days or many months. Because of this, the development of medical practice management software has allowed clinical managers to better streamline the flow of information between patients, the medical healthcare facility, and insurers. This has allowed healthcare facilities to operate more efficiently and with reduced costs.
When a medical record is created, many kinds of information are needed. This includes the patient’s name, address, their social security number, home and work telephone numbers, and the identifying insurance policy identity numbers. Summary of treatments are also included in the record, as well possible diagnosis routes. All of this information must have corresponding procedure and diagnosis codes that are entered into the information system that the healthcare facility uses to process payments for treatments. Healthcare facilities use either licensed software package systems to input and manage this information, or utilize full portal web access through a software company’s website. Often the latter solution is cheaper for the healthcare facility since the licenses for software package are expensive and must be renewed. Because new companies and new solutions are constantly being brought to the market, healthcare facility managers often have crucial decisions to make when adopting new information systems, and the change from one system to an upgraded one can often be costly in terms of time and resources spent on training and switching over old records.
These systems need to be effective to prevent the misuse of that information, particularly in fraud and mismanagement. The private information of patients needs to protected, and the transactions between patients, insurance companies, and medical facilities often involve large sums of money. Thus, it is vital for the healthcare manager to have a thorough understanding of the medical billing system and the changes that have occurred to better manage their staff and patients.
Wendy Hacker writes for education blogs where you can learn more about the healthcare administration degree.