PAP Department: Collecting Accurate Patient Data for Billing Efficiency - Essay Sample

Introduction

The PAP department is mandated to provide facilities other than clinical treatment when an individual visits a hospital seeking treatment. The department collects the patients’ data and eases the billing process for them. The PAP must collect patients’ information that is accurate since third parties such as insurance companies which are involved in healthcare provision to their consumers. The insurance companies pay bills for the patients who avail healthcare services from healthcare facilities; thus, inaccurate personal data makes it problematic for a healthcare facility to identify and coordinate with the insurance entity concerning bill settlement. Occasionally, the patients may be forced to pay despite having health insurance due to a lack of communication-based on inaccurate data, which leads to reduce welfare. Thus, there is a need for exceptional healthcare service in terms of quality and satisfaction of the patient. It improves their social development since people are more healthy.

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Third-Party Billing Policies

Third-party policies can be used when creating billing guidelines for the administration and patient financial services (PFS) personnel for maximum patient reimbursement. It is imperative to comprehend the third party's cycle of revenue for accurate billing and proper payment (Welton & Harris, 2007). The healthcare billing unit must ensure that all treatment charges are documented and accounted for accurately; this makes a big difference in the patient charges and reimbursement for the healthcare facility. Most third parties require that treatment matches the patient's diagnosis, thus, correct patient information ensures that they are maximum reimbursed.

Maximization of Reimbursement

The key areas of review for maximum reimbursement are as follows in order of importance. First, the PAP must record accurate personal data of the patient to avoid reimbursement delay. Second, the patient diagnosis must match with their treatment, thus, PAP should ensure that these documents are matching. The health facility should provide value-based care. Lastly, the facility must make good reimbursement claims from the third-party. The rationale is effective since correct personal data and matching diagnosis and treatment of the patient makes it a clean claim and eases the third-party entity with the healthcare unit.

Follow-Up Structure

One of the most significant aspects if medical reimbursement is follow-up. The biller must-read reports and communicate with third parties. The health unit must establish a deadline for unpaid claims, for instance, those older than 40days. Second, prioritize large claim amounts before following up on small claims. Use billing software that allows the biller to automatically receive feedback in case a claim has a problem. Lastly, in case a clearinghouse does not provide a reason for the claim reimbursement delay, make a call to the insurance carrier. Thus, thinking of follow up as an investment will make the health unit profitable.

Plan for Periodic Review

The hospital should appoint a compliance officer who reports to the compliance program medical director. They should report to the chief financial officer of the facility and its general counsel. These individuals should hire staff who periodically review guidelines for coding and documentation of medical services. They should also provide in-service training of billing staff, doctors, residents, and providers. They should also coordinate system-wide audits of outpatient and inpatient clinical records.

IV. Marketing and Reimbursement

Strategies Used to Negotiate New Managed Care Contracts

Managed care contracts are a necessary aspect of a sound financial strategy (Vega, 2013). To negotiate a new contract successfully with the payer, health providers prepare for a negotiation, collaboration, and compromise. Thus, the health organization should solidify its expectations of the contract negotiation, while appreciating the requirements of the payer (Vega, 2013). The company also sets positive goals for their relationship with the payer. Further, they look beyond the rates for compensation and consider the workflow impact for the new contract and develop a payer profile before or during negotiation (Vega, 2013).

Staff Role in Managed Care Contracts

Administrators, coders, and managed care directors play a crucial role in negotiating managed care contracts. Financial managers manage risk and resources in a manner that achieves better contract terms with the payer. Physicians also participate in the negotiation and are the key decision-makers.

Managed Care Contracts Reimbursement Impact

MCO in the health care market influence care delivery by linking the patient to the service provider. MCO impacts reimbursement in the sense that the contracted provider and the payer agree on partial liability for financial rewards and risks involved in cost-effective care for the members who are registered in the plan and allocated to a particular provider (Kate et al., 2004).

Billing and Coding Compliance

Internal audit resources would help identify any billing and coding compliance issues. The healthcare organization should conduct internal auditing and monitoring, implement practice and compliance standards, and designate compliance offers. Besides, open lines of communication should be developed and disciplinary standards enforced. The organization is also required to handle compliance investigations such as self-disclosure protocols.

References

Kate Bundorf, M., Schulman, K. A., Stafford, J. A., Gaskin, D., Jollis, J. G., & Escarce, J. J. (2004). Impact of managed care on the treatment, costs, and outcomes of feeforservice Medicare patients with acute myocardial infarction. Health services research, 39(1), 131-152. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360998/

Vega, K (2013). Successfully negotiating managed care contracts. Healthcare Financial Management Association. https://www.hfma.org/topics/trends/16658.html

Welton, J. M., & Harris, K. (2007). Hospital billing and reimbursement: charging for inpatient nursing care. JONA: The Journal of Nursing Administration, 37(4), 164-166. https://journals.lww.com/jonajournal/Fulltext/2007/04000/Nursing_Intensity_Billing.3.aspx