| Autor: |
Fran Sorrell, Alice S. Weissfeld, Vickie S. Baselski |
| Rok vydání: |
2014 |
| Předmět: |
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| DOI: |
10.1128/9781555817282.ch36 |
| Popis: |
This chapter illustrates the importance of hiring individuals well versed in all aspects of correct coding, including the rules and regulations. It discusses the importance of having a comprehensive information technology platform and software resources that ensure accuracy and completeness. The chapter explains the need for laboratory personnel to be involved in the billing process and to maintain a close working relationship with members of the billing department and the relationship between complete and accurate billing and the generation of sufficient income to continue to perform expected functions. An understanding of the specific requirements for billing laboratory services and a systematic approach for ensuring that the processes are carried out as specified are key to the financial success of a laboratory. While the entire laboratory test process from test order to test result reporting to payment for services involves several categories of individuals, the actual billing process can be considered in terms of two main categories: provider mix and payor mix. Each individual payor sets criteria for payment for services. Both Medicare and Medicaid are third-party payors; payment for services provided by a healthcare provider to a patient is made by a contracted entity. Each payor may interact with each provider through one of two main types of payments: retrospective and prospective. Claims for payment are generated for submission to thirdparty payors, while invoices are generated for contractual payment by clients or by patients. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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