The scenario is inaccurate coding and lack of patient information which delays payments for the doctor. As head of the billing department a process will be implemented to solve problems on this issue. The current process is not working and because of the loss of productivity, a team was assembled to solve problems. The goal is to find where the error is, and recoup the loss revenue.
The first person to question would be the front office personal who checks in a patient upon arrival. After getting the insurance card and demographic page, it is important to compare that information on file to be certain it is accurate, and up to date. A copy of the insurance card should be taken at every visit. Even if the patient were there just there a few weeks ago, it is important to establish a routine of quality. Second, the front office personal should check the insurance carrier to see if a referral is necessary. However, most insurance carriers do not require a referral for family practice it is advantageous to determine if the doctor is in network.
When the patient is called back to their examining room, the medical assistant will ask for the reason for the visit. It is up to medical assistant to write down the signs and symptoms of the patient. The documentation must be detailed and recorded properly on the patients face sheet. The department manager of nurses should be scrubbing the documentation before it is submitted to the billing department. For example, if a patient has a routine check and the physician decides to order labs, the lab draw must be documented; even though it was not the...