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