Departmental Impact on Reimbursement
3-2 Final Project: Milestone Two Draft
HIM-345 Healthcare Reimbursement
Shane Standart
Southern New Hampshire University
Departmental Impact on 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.
This reimbursement cycle typically begins with the patient seeing a provider for a need. These
appointments are often scheduled while others are walk-ins, but this usually has no effect on
billing for an office visit. At this time, the front desk staff will take in all the normal patient
demographics including insurance information. 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).
Additionally, the motivation behind providers are ensuring their staff, on site and off, is current
with the updated ICD-10, CPT and HCPCS codes, and being appropriately educated in these
areas as well, is to realize the cost for their office and all organizations involved in the cycle
when an incorrect or incomplete claim is sent out. This can have a domino effect on all directly
and indirectly involved and is wholly unnecessary in today when there is so much information
and education available to greatly reduce, if not stop errors completely. So, unless the data
Departmental Impact on Reimbursement
entry process is completed accurately and in a timely manner, the reimbursement cycle will be
impacted (Crocker, 2016).
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 department or similar). This department now has, among a few
responsibilities, the main responsibility of ensuring billing maintenance and coding compliance
-- especially following all rules and regulations regarding HIPPA, Medicare and AHIMA. The
information administration and governance of data practices provides cohesive policies,
processes of rights and responsibilities for effective management of health information
(Crocker, 2016).
Lastly, while there are many departments involved directly and indirectly and also working
independently and co-dependently, the departments mentioned in this paper have a vital and
sometimes overlooked importance to the reimbursement cycle. The rol