question archive Why is coding important for submitting for reimbursement from a third party? What are the pro's and con's for having a system that is almost entirely dependent on insurance (third party) reimbursement? For your citation, you might use articles that show examples of?third-party reimbursement systems
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Why is coding important for submitting for reimbursement from a third party? What are the pro's and con's for having a system that is almost entirely dependent on insurance (third party) reimbursement?
For your citation, you might use articles that show examples of?third-party reimbursement systems. You can also find articles from experts that suggest?the advantages and disadvantages offered by these third parties.
Medical coding is important for patient care. Since it takes the patient's information about treatments, diagnoses, procedures, equipment and drugs issued out to the patient, it enables the insurance company to understand what they are being charged for.
Step-by-step explanation
The information that is collected through coding originates from electronic records, transcriptions, lab results as well as medical notes and are able to show what the third party paid for as far as the patient care is concerned. Since it determines how insurance reimbursements are done it has an impact on patient care outcomes.
Coding is also important when submitting reimbursements from a third-party because they are useful in regulatory and contractual compliance. HIPAA protects the confidentiality of patients, which calls for coding in order to ensure that no patient private data is leaked. Another benefit is that it ensures payment flow.
It ensures smooth operation of the revenue cycle of the third party as well as the health facility where the patient is treated. They require an understanding of the various medical regulations concerning the payment of medical bills and these include claim follow-up, posting of payments, claim denial resolution, appeal submissions and bill adjustments.
With regard to the pros of having a system that is almost wholly dependent on insurance reimbursement, the first benefit would be the fact that it enables focus to be placed on cost-effective decisions concerning the care of patients. Secondly, it ensures that there is no quality compromise in terms of how patients are treated.
Thirdly, it brings up innovations such as price transparency tools which assist patients in noting any healthcare re-imbursement changes. When it comes to the cons, the first one would be very costs for people even for those who have embraced plans through their employers. These costs may be so high that most people will struggle to make payments. Lastly, such a system may grapple with the reality that insurance coverage may not be sufficient to cover all the costs of surgeries, tests and procedures that have to be done.