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Billing Process

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Submitted By paulkhalil
Words 843
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Paul Carter
HCA-240 Health Care Accounting and Billing
April 6, 2013
Professor York
Billing Process What is the process that is utilized when producing a final bill? In which ways are pricing and charging different in health care from other industries? What are the ways that private and government insurers and payers impact the actual reimbursement process in health care? The process for producing a final bill in health care starts with the medical record and coding which are communicated to the payer to start the payment process. In 1996 the Health Insurance Portability and Accounting Act (HIPAA) designated two specific coding systems to be used when reporting to both public and private payers. The two coding are International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and Healthcare Common Procedure Coding System (HCPCS). The ICD-9-CM provides information for diagnoses and procedures while the HCPCS just provides information in the procedure area. The next process would be the charge entry and charge master which have to do with the capture of charges for the services performed, incorrect billing and billing late charges. With charge capture can be done in two different ways paper documents or charge slips. Which is done by the data processing or the business office that identifies the services that was performed on a patient? When producing a final bill they will also sometime use the charge explosion system that will use one code that will explode into a list different codes use for supplies that were use. Then there are some that may use the charge code (CDM) which breaks it down into six common elements, charge code, item description, department number, Charge/price, revenue code, and CPT/HCPC codes. “For most healthcare providers medical claims fall into one of two types: CMS-1500 and CMS-1450 (UB-04). The CMS-1500…...

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