Essays on Medical Billing

IT in Managed Care Organizations

Introduction The most important function of information technology (IT) in managed care organizations (MCO) is to support their business. MCOs are complex in nature, offering a wide range of services to a wide range of individuals. It is vital for management to align its IT department with the operational dynamics of the organization. In this situation, it is important fo an IT department to align its goals to managed the complexity of MCO. A MCO should reduce risk if they have a well-function IT department. Thus, the IT department main concern is designing, implementing, and operating an efficient system ...

Medical billing is an iterative process that involves the translation of a healthcare service or product in a billing claim. Ideally, the medical biller has the responsibility to make sure the healthcare institution receives sufficient reimbursement for the services provided by the medical practitioners. The responsibility of the biller may vary from one institution to the other based on size and capacity of the healthcare facility. Ultimately, the medical biller must have specialized knowledge regarding medical records and just like the medical coder; they must have strong familiarity with ICD-9-CM, CPT and HCPCS level II codes (Smiley, 2012). Most ...

In the healthcare industry, failure to efficiently collect patient revenues, or to invoice and receive payment for services, can seriously undermine a practice’s ability to meet its obligations, much less profit. While it is essential to weigh the balance between profitability and the provision of high quality patient care, it is also important to establish a revenue management cycle that is aimed at capturing and managing patient service revenue (Oregon Health and Science University, 2016). As such, the following recommendations can be made, as it relates to the selection of Hamilton-Reach Financial Services as a collection agency, or ...