In replying to the postings, you are to critically evaluate all of the following for at least two main postings:
Are the explanations of the roles of each of the five components listed above clear, complete and accurate? If not, explain.
Is there a clear relationship between each of the five components described and the hospital billing system?
Provide at least one addition to one of the component descriptions (identify another person, organizational component, process, data element, or aspect of technology)
The hospital billing system is a complex tool utilized to provide accurate accounts of patient services. The fundamentals of which address the people using the system, components, processes, data/information and technology. When properly used the billing system is an effective tool for the procurement of financial obligations for services rendered, but when accessed in the wrong way it has the ability to hurt the hospital, patients, employees or all of the above.
People: Any person in contact with a patient is potentially one who uses the billing system and subsequently any person in contact with patients, whether direct or indirect, are responsible for billing. Doctors, nurses, pharmacists and secretaries are responsible for ensuring that charges are properly submitted for billing, while indirect patient services such as EVS and food service costs are built into the cost of hospitalization. Everyone involved in the usage of the billing system, as well as the patients, are affected by the system. Missed charges related to patient care can cause a financial deficit and negatively impact the staff in ways such as missed raises and poor working conditions. Extra and wrong charges can cost the patient extra money as well.
Organizational Components: All departments use the billing system in a hospital. Central Electronic Health Records can be accessed across the hospital ensuring that charges are properly entered and ultimately submitted to the insurance companies for reimbursement. For example when a patient leaves a unit for a procedure or test, technicians can access the EHR to enter charges, which all members of the health team can access. This spreads the accountability across all members of the health care team.
Processes: Data entry is the primary process in which all users of the billing system are engaged. Without the entry of data into the hospitals EHR, charges cannot be determined and therefore revenue for the hospital can be lost.
Data/Information: Many data elements are important in the billing system but the top 5 are: Patient identification, patient demographic information(billing address, contact info), insurance information, dates of service/services rendered and service providers identification. Without these key elements there is a potential for missed revenue and lack of payment.
Technology: Technology is now the backbone of medical billing. With the addition of the EHR in the 1960s, data entry became streamlined and more easily accessible than the previous paper filing and faxing of records. It is expected that the EHR and billing system be secure and the utilization of an EHR does not come without its risks. Security breeches, although rare in this day and age, can occur in a hospital putting the patients at risk of identity theft. It is also expected that technology operates seamlessly and without interruption. Temporary interruptions in technology are expected on occasion for upgrades but as a whole, healthcare professionals expect the technology to operate and rely on this technology to properly perform their jobs.
Are Hospital Billing Practices Unethical? Chargemaster Still Used To Boost Revenue. (2017). Medical Ethics Advisor, 33(6), 1–3. Retrieved from http://search.ebscohost.com.ezproxy.umuc.edu/login.aspx?direct=true&db=ccm&AN=123350952&site=eds-live&scope=site
High Cost of Billing and Collections: EHRs not helping. (2018). Health Care Collector: The Monthly Newsletter for Health Care Collectors, 31(11), 1–11. Retrieved from http://search.ebscohost.com.ezproxy.umuc.edu/login.aspx?direct=true&db=heh&AN=128629383&site=eds-live&scope=site