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Medical groups nationally are struggling with reimbursement levels, writes author Suzanne Anderson. Groups effectively dealing with the problem realize the solution is not restricted to the billing office but rather begins prior to providing service and lasts until well after payment is collected.
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Beginning with this issue of Physician Executive, members of the Society on Insurance of the American College of Physician Executives will provide an ongoing column for readers on the unique point of view of the health care insurer. The column starts with an offering by the Chairman of the Society on the physician executive's role in resolving the anomalies of the health care payment system.
Incomplete and inaccurate patient records have always left hospitals vulnerable to losing malpractice suits. But increasingly, good records mean hospitals are more likely to collect on bills that are scrutinized by utilization review firms, Medicare peer review organizations and other such bill examiners. That places a higher premium than ever on paying meticulous attention to a patient's medical record.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Health information professionals have a lot to offer physicians and their office staff. This is one example of an active physician support service department and the valuable contributions it makes in educating physicians and staff.
Public demand for healthcare cost reductions has not only risen to the top of the political agenda this fall, it has become strident. Legislators are under pressure to act quickly. Suddenly, electronic claims submission is being understood for its ability to lop billions off of the staggering cost of healthcare administration. Several initiatives are now in the works that are set to bring ECS into widespread use.
Electronic data interchange has the potential to save billions of healthcare dollars--that's the gospel according to Joe Brophy. The Travelers Insurance Company president and co-chair of the Health and Human Services Workgroup on Electronic Data Interchange is taking this sermon to the people.
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The 1993 chair of the Health and Human Services' Workgroup for Electronic Data Interchange's Financial Implications Technical Advisory Group predicts big savings from EDI under the Clinton healthcare reform plan. A cost/benefit analysis by the TAG foresees net cumulative savings from EDI of $42 billion by the turn of the century.
The process of billing an insurance company for health care services has changed radically. In the past few years, the emphasis has been on automation. The change is fueled by the opinion of cost containment experts who claim that automation will help reduce costs in the U.S. health care delivery system. Key to success for the provider in adapting to this change will be understanding the coding used in the billing process and following standards of accuracy and fairness. This article is not intended to represent the adjudication rules of any particular insurance company. It is the result of experience as a practicing surgeon and as a consultant in the health care field.
For many healthcare providers, the greatest problem with third-party payers is getting them to pay the benefits they are contractually obligated to pay. However, another problem that arises consistently--thought less frequently--is what to do when a third-party payer provides benefits that it is not contractually bound to make and then demands the payment be refunded. One answer to this problem may be to just say "no."