Critical Case for Billing and Coding

Critical Case for Billing and Coding

Billing and coding are the foundation of the health care revenue cycle that certifies that the payers and patients compensate healthcare providers for services offered. Medical billing and coding express the patient experiences in languages that healthcare organization uses for claims submission and compensation (Nowick, 2022). The two are different undertakings essential for healthcare providers to compensate for the services offered.

In the critical case for billing and coding scenario, the root causes for the reduction in revenue are administration errors in coding, a problem with the Medicare payments and coding, and the chargemaster. Administration errors in the coding lead to a decline in revenue in the workplace. This is because the use of injectable and metallic medicine covered the three months of the years, and the processes were not coded. After running the volumes report and looking at specific drug codes, they concluded. In addition, they ran the revenue and usage summary and compared the current year to the last year to check the number of items billed by the charge code and payer. Later, they broke out the volumes in the inpatient and outpatient areas. The analysis showed that the regulations for the two drug types differed from the previous year.

Another root cause was a problem with the Medicare payments and coding. Meredith emphasizes that Cheryl and Michael should look for missing procedure codes or a listed procedure that lacks a product attached to it. The inspection of procedure coding will help in identifying the discrepancies in what Medicare expects. Later after the review, they learned that all the Medicare payments were off. Lastly, the charge master was another cause of revenue reduction. The charge master was not recording codes properly in the billing list for the metallic and injectable drugs.

We can mitigate the impact of coding and billing by avoiding administration errors in coding by being careful when coding. Having the right software would have helped ensure that charges are being generated and reviewing claims. However, ensuring that the chargemaster lists all the extra codes that Medicare requires for its outpatient would have helped mitigate these impacts.

Increasing training, moving to cloud computing for our editing program, and having the right software could solve this problem. Training helps in reducing employee turnover in workplaces. The fact that there was high employee turnover in the coding and billing department might have led to errors that caused revenue reduction. Moving to cloud computing is vital in reducing operational risk and ensuring regulatory standards are met and controlled. Reducing operation risk plays a crucial role in minimizing losses, thus increasing revenues (Nowick, 2022). Lastly, having the right software enhances efficiency, saves time, and improves data quality. Right software minimizes coding errors, thus strengthening the financial management in healthcare facilities.

In conclusion, coding and billing are significant healthcare revenue procedures. The smooth running of medical coding and billing ensures that healthcare givers are compensated for services offered and help in ensuring that healthcare facilities deliver patient care. Proper coding and billing process monitoring enhances payment generation by reducing errors and reviewing claims, thus increasing revenues.

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Nowick .M.  (2022). Introduction to Financial Management of Healthcare Organizations (8th edition). Healthcare Administration Press.




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