Claims management is the art of consolidating

 

Claims management is the art of consolidating, billing, filing, revising, and managing medical claims, an imperative aspect of the healthcare industry. Medical facilities cannot receive due funds if patients are unaware of how much they need to pay. Ensuring provider organizations understand the fundamentals of medical billing and coding can help providers and other staff operate a smooth revenue cycle.

Tasks:
Explain some of the common medical billing and coding challenges/issues.
Explain the impact of improper claims management.
Describe how technology can be helpful when it comes to medical billing and what tools are available.

Sample Solution

How accurate are the claims submitted by your medical billing department? Given the complexities of the medical coding system, it is not surprising that mistakes are made. Common medical coding include, among others: not coding the highest level; bad documentation/missing documentation; not having access to the provider; and failing to use current/updated code sets. The coder`s job is to code to the highest level of specificity. This means abstracting the most information out of the medical reports from the provider and taking accurate notes. It also means knowing the medical terminology for both procedures and diagnoses. Coding to a general level, or undercoding can lead to a rejected or denied claim.

(2005), Kutsienyo (2011) and Sibindi and Bimba (2014) recorded exact proof of Gross domestic product development influencing emphatically on the financial area and rising expansion antagonistically influencing banking area development. IMF (2011) announced the chance of unfortunate resource nature of Ghanaian banks ought to the macroeconomic imbalanced wait on.

The 70% development on non-performing credits from 2015 to 2016 is unfortunate for bank benefit, dissolvability and monetary turn of events (Lowland, 2016, IMF, 2016). Baabereyir (2009) and Ngwa (2010) believed that credit risk is the main gamble banks are vulnerable to and Ghanaian banks are no special case.

Arrangement of portable cash administrations by telecom organizations is seen as a danger by 55.6% of Ghanaian banks in the 2016 financial overview. While portable cash balance on float grew multiple times from 2012 to 2015with exchange volume of 266.3 million, customary bank stores became by 116% from GHS 19.6 billion to GHS 42.2 billion for a similar period. Banks dread telecom organizations are contenders rather than accomplices in the goal of monetary consideration (Lowland, 2015; PwC, 2016).

End
Banks are irreplaceable to financial development. Sound guideline and oversight of the financial business is vital for cross country advancement (Allen and Carletti, 2008; Singh, 2010).

Execution of regulative and underlying changes repositioned the Ghanaian financial area from chapter 11, credit proportioning, low monetary intermediation, cash-overwhelmed framework and loan fee controls to a market-based framework. Changes reinforced the independence of the national bank to figure out systems, improved contest, prompting a very much promoted and beneficial industry directed by local and reception of global prescribed procedures.

Utilizing on innovation, expansion of electronic financial administrations and items and the hope of banking areas of emerging nations outperforming those of created nations, Ghanaian bank entrance is projected to increment to rope in the unbanked people, address issues of high loaning rates to relieve the dangers inclined toward the area.

Proposal
To outfit the ideal potential for improvement, the national bank ought to urge banks and telecom organizations to team up to help rope in the unbanked people which has positive ramifications on monetary steadiness and macroeconomic turn of events (Mehrotra and Yetman, 2015; Burgess and Pande, 2005; Le

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