MHA FPX 5006 Assessment 2 Proposal for Billing Changes

Student Name

Capella University

MHA-FPX 5006 Health Care Finance and Reimbursement

Prof. Name

Date

Proposed Changes in the Billing Process and Procedures

Automation of the Billing Process

As the healthcare industry readies itself for current and future challenges, it is vital for us to maintain a competitive edge by reassessing our existing billing system. This reassessment entails evaluating system efficiency, operational capacity, and billing accuracy. Currently, physicians in our facility manage billing responsibilities instead of employing dedicated medical billing and coding personnel. A comprehensive analysis reveals inefficiencies in this decentralized approach, prompting the necessity to update billing policies and standard operating procedures.

To enhance effectiveness and efficiency, our organization must embrace automation and integration in its billing process (Gupta, 2020). Billing lies at the core of healthcare provision and organizational revenue generation, necessitating comprehensive changes. Thus, the following billing adjustments are proposed alongside the recruitment of adequate medical billing and coding staff:

Promptly Handle Rejected Claims

The clinic should enforce a new policy mandating prompt follow-up on denied claims. Despite automation and proper coding, denied claims remain inevitable. Therefore, establishing a four-week timeframe for medical billers to resolve rejected claims with insurance providers is essential.

Clarify the Collection Process to the Patient

Transparency in the billing process is crucial for successful medical claims management. Implementing a policy that requires healthcare professionals to educate patients on their financial responsibilities before their initial appointment is essential. This proactive approach ensures patients are informed and minimizes misunderstandings regarding payment obligations.

Maintain and Update Integrated Patient Files

Consistency in claims necessitates up-to-date patient information integrated across the organization (Gupta, 2020). Healthcare practitioners should verify patient demographics and insurance coverage regularly, especially during insurance changes. This proactive approach ensures accurate billing and minimizes claim rejections.

Step-by-Step Revenue Cycle Management

Efficient revenue cycle management entails a structured approach:

Step	Description
Patient Registration	Front desk staff collect essential patient information for appointment scheduling.
Insurance Verification	Outsourced billing services authenticate patient coverage, examining policies and eligibility.
Patient-Doctor Meetings Recording	Documentation of patient encounters assists coders and billers in accurate coding and billing.
Medical Transcription	Transferring patient meeting data into a format suitable for billing.
Medical Coding	Assigning clinical codes to transcripts simplifies billing procedures.
Charge Entry	Billing for services rendered before claim submission to insurance companies.
Charge Transmission	Submitting claims to payers, either electronically or via government channels.
Accounts Receivable Management	Monitoring claims post-submission to ensure efficient payment processing.
Denial Management	Addressing denied claims promptly to rectify errors and expedite reimbursement.
Payment Posting	Recording payment status and providing Electronic Remittance Advice to patients.

Pricing Structure and Insurance Contract Negotiation

Utilizing the cost-based pricing method ensures transparency and competitiveness:

Pricing Factors: Differentiation, cost analysis, company objectives, and market demand influence pricing decisions (Sanchita, 2021).
Negotiating Insurance Contracts: Key considerations include fee schedules, timely payment clauses, and credentialing procedures (Gwilt, 2016).

Private Pay and Charity Care

The clinic adopts a flat fee for private pay and offers charity care for patients in need (Montgomery, 2020).

Billing Software System

Implementing cloud accounting software enhances accessibility and efficiency in managing financial data (Sage, 2021).

Benefits of Proposed Changes

These changes promise enhanced efficiency for the clinic, physicians, and patients alike. Automation streamlines processes, reducing errors and enabling faster service delivery (Minolita, 2016). Patients benefit from improved access to healthcare services and transparent billing practices. Additionally, efficient billing procedures facilitate prompt payments, ensuring financial stability for the clinic.

References

Gupta, A. (2020). Transforming Healthcare Revenue Cycle Management through Automation. Healthcare Financial Management, 74(6), 30-35.

Gwilt, R. (2016). 6 Key Things Medical Practices Should Consider When Negotiating Payer Contracts. Retrieved from https://nixongwiltlaw.com/nlgblog/2016/3/14/jp5r4aew25nu3r9h6joqgku63tab3m