First, the agency I worked for was JCAHO accredited, and I worked on several projects preparing for surveys. As a member of executive management, I participated in both opening and closing meetings, as well as parts of the survey that dealt with Information Technology and/or HIM/EMR areas.
Second, in the healthcare industry, HIPAA brought some major changes to internal business processes. The first was the development and tracking of a Communication Log, tracking each time information from the client's medical chart is released to anyone outside the agency. However, the bigger issue was the entire re-write of the billing process. We implemented 837 compliant billing, for Medicaid, Medicare and commercial billing. One of the advantages of this was our ability to begin billing directly with Medicaid, reducing our use of a clearinghouse (and the subsequent fees). This saved the agency, literally, thousands of dollars a year.
An 837 compliant file had to be created for each funding source, based on details related to the bill in order to meet all the federal requirements. I set up agency rules on each unique type of charge they have in order to be sure the billing details were correct. Over10,000 rules were required for this process. Rules had to be specific not only by payor source, but by the credentials of the staff person providing the service, the duration of the service, the location of the service, as well as the full and computed fees. Some rules actually set the fee for that service, while others defaulted back to the CPT code fee rate.
However, another great time saver for staff in the Accounts Receivable Department was the inception of the 835 to automatically post electronic payments back to charges. This saved many hours of staff keying on payments individually. Over $700,000 a month was posted using the 835 process; this reduced the time needed to close a month financially by several days. Again, there were rules that had to be set up for each payment.
Well, while I bring a skill set to any industry that is valuable, I did want to highlight some of these specialty knowledge areas in the healthcare industry.
Thanks for reading. If you want more information or might be able to provide some contract/positon leads, just leave me a comment.
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