Billing, Marketing, and Reimbursement
5-2 Final Project: Milestone Three & Four Draft
HIM-345 Healthcare Reimbursement
Shane Standart
Southern New Hampshire University
Billing, Marketing, and Reimbursement
For the healthcare reimbursement there are many departments, all of which have an equal and
vital importance. Each department must work independently and co-dependently with every
other department this whole cycle to work. Without this shared participation, patients and
providers are the ones who are directly affected, and this can have unnecessary consequences
on all parties involved.
While this entire is complicated and many steps are needed for the goal of payment and
reimbursement to happen, the drafting of the bill typically starts with the patient visiting a
provider for a service or treatment. This the time where the essential and appropriate data
needed to initiate a draft of billing is taken. This is often taken by the front desk or depending
on how modern a provider's office is, sometimes taken immediately taken by the billing office
who often has medical coders to get a quick, efficient start.
The collection of the data taken by the front desk or even immediately by the billing
department is reviewed for accuracy and will eventually apply all necessary medical codes for
any and all services and treatments the patient received. This information is then entered into
their system to first establish or continue a patient's medical record, while also making this
information available for the billing department on site or a third-party biller will then begin the
process of sending the patients information to the correct insurance(s) companies.
What is important during this stage is that medical coders and staff entering the intake data
being proactive in ensuring all the correct data is entered into their system. Any inaccurate or
incomplete information will result in a denied claim or incorrectly paid one. Providers can also
be proactive here by having the most up to date software for their staff as where gaps are
identified, the billing staff should be equally educated so they are aware of the correct and
appropriate codes and using them consistently (Andrews, 2016).
Billing, Marketing, and Reimbursement
Additionally, this when third-party payers come into play and all of the information and data
taken by the front desk or billing department at the providers office becomes so important to be
accurate. As unless the data entry process is completed accurately and in a timely manner, the
reimbursement cycle will be impacted (Crocker, 2016). Third-party payers employ a fee-for-
service for reason -- to ensure the handling of claims from the receiving of, to privacy
protection and payment is all done legally, timely and accurately. The third-party payer is also
where the strategy was established for intermitted evaluation of processes to ensure compliance
(Role of third-party billing firms expanding in health care area, 2002).
One department that often gets overlooked in its importance and use is the health information
management department (or what was once referred to as the medical record department or
medical information departmen