1. People – who are the people that use the billing system? What other people are affected by the billing system?

Primarily, the business office deals with the billing system. Hospitals usually have a specific department for billing, where a billing professional handles working within the system. There may be multiple billing professionals on staff depending how large the organization is. These professionals ensure that they are properly paying and reimbursing parties involved. Hospitals may also outsource billing to a medical billing service.

First and foremost patients are affected by the billing system as well as third party payers / insurance companies. For example, if something was billed incorrectly or if a patient has more than one health insurance, that may cause difficulty.

2. Organizational Components – what departments use the billing system? What other departments or outside organizations might be involved?

As far as departments, if a hospital has a department directly for billing they use the billing system. Administration as well as receptionists have access to the billing system. Outside of these departments there are coding professionals who input the codes that vary by company. Billing and coding works hand in hand to ensure that everything is correct.

3. Processes – what activities (processes) are the users of the system engaged in? (please do not just say “billing”!)

“Registration, establishment of financial responsibility for the visit, patient check-in and check-out, checking for coding and billing compliance, preparing and transmitting claims, monitoring payer adjudication, generating patient statements or bills, and assigning patient payments and arranging collections.” (The Medical Billing Process, n.d.). These are all activities that are needed in order for billing to take place.

4. Data/information – list 5 data elements or information items that are important in the billing system.

Personal information, current insurance policy information, payment history and outstanding balances, allergies/health conditions, and compliance with HIPPA.

5. Technology – how does technology support the billing system? What are some expectations you have about how the technology performs?

Technology supports the billing system in several ways. It houses patients information, insurance, and financial history. These are all important to access very quickly especially in a hospital setting. Having the technology for patients to log into a patient portal to see health records as well as any outstanding balances and statements may also help make transactions go as smoothly as possible.

There are always issues that need to be worked out but I would expect the technology to perform very effectively and efficiently.

Reference:

The Medical Billing Process. (n.d.). Retrieved from https://www.medicalbillingandcoding.org/billing-process/

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Please respond with a paragraph to the following post, add citations and references:

The best way to get a hospital to implement an outreach program is to communicate to executives like our CEO and my stakeholders through written along with face to face communication. The first important thing to do would be to explain the idea or ideas that I have for an outreach program. For example, I believe strongly in heart failure clinics for Congestive Heart Failure patients. I have recently visited a new by cities program and have seen how successful it has been.

Using billboards, bulletins, emails, scheduling meetings with the board of nursing along with the CEO to share this vision with them would be a great way to start to get the word out. I would need to have all the information to discuss the plan for the outreach program, i.e. heart failure clinic. This information would include: metrics, measures of performance and success rates of how patient’s less than 30-day readmissions were decreased after following a program. This would show ad prove the importance of the out-reach program and how it will help overall population of the CHF patient’s remain in compliance with their medication and activities.

Following an action plan and execute these following steps will ensure to communicate effectively to the stakeholders involved.

1. Communicate- have a clear, concise plan to present your vision to the stakeholders

2. Learn how to embrace change

3. Plan for implementation within the organization

4. Design a model or tool used to put the plan into operating action (“amanet.org/training”)

Reference

(n.d.). Retrieved January 27, 2019, from https://www.amanet.org/training/articles/transform…

-vision-into-reality.aspx

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