Medical billing is the submission of claims to health insurance providers and/or patients from healthcare providers.
our experience with medical billing software
Here are a few of our medical billing software projects
- Connecting an EMR to a billing system with HL7
- Creating customized export files to send to ERP software to submit billing
- Integrating a Second Opinion application to billing software with the Medstat format files
pay for performance and its impact on medical billing and coding
Overview
With pay for performance policies, the idea is that medical providers should be reimbursed for the health results that they achieve, rather than the quantity and difficulty level of procedures that they perform.
Before pay for performance, medical providers who did a poor job may have been paid more than those who did a good job. The reason is that poor care creates more medical procedures due to complications. These additional procedures are often done by the same healthcare provider – earning them additional fees.
Pay for performance is set up to try to increase payment to those who provide better care and reduce payments for care caused by mistakes. For example, if one hospital’s patients are getting staph infections at a much higher rate than any other hospital, then they should be paid less for treating the infections as they are probably a result of sloppy care.
Pay for performance impact on medical coding and billing
The focus on making sure that patients are getting better relative to others in the field will cause medical coding to become much more important. For example, let’s say that those in the top 20% of performance get a bonus. If they don’t code a pre-existing condition for that patient on their first visit, then those existing conditions which have to be coded on a subsequent visit could seem like they were caused due to poor or incomplete care. With all else equal, those medical providers who correctly code all pre-existing conditions on the first visit will appear to be doing a better job at delivering care as they won’t have to add other conditions later in the therapy.
This will make it much more important to correctly identify all of the diagnoses of each patient during the first visit – otherwise it could be interpreted that the low quality of care caused complications.
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