Best Practice Guidelines: Healthcare Practice Management & POPIA Compliance Framework: Billing: Roles & Purpose

Best Practice Guidelines: Healthcare Practice Management & POPIA Compliance Framework

Best Practice Guidelines: Healthcare Practice Management
&
POPIA Compliance Framework

GoodX online Learning Centre

learning.goodx.co.za

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9. Billing: Roles & Purpose

Responsible Roles

	Operational Role: Do billing and switching whilst treating the patient, or provide clear, readable and correct descriptions or ICD10 codes to the Billing Expert to avoid rejections. (Timely communication and billing will ensure that patients don’t leave the practice after switch rejections due to, for example, insufficient funds.) Keep a record of procedures and all medicine and materials.
	Management Role: Design and check the process to get files and billing notes from the Practitioner to the Billing Expert and check that all billing is daily up to date. Ensure the prices on the system is always up to date. Adjust private rates on the system when the practice increases/change prices.
	Operational Role: The Billing Expert needs to have advanced knowledge of the speciality’s billing codes and rules to ensure accurate and optimal billing. Ensure all medical aid billing is switched/sent to the medical aids and ensure all corrections are done. All billing must be done daily to ensure correct figures and healthy cash flow. Private patient billing must preferably be done before the patient leaves the practice, so the need for debt collection is limited.
	Operational Role: Check that all billing and corrections were done and all medical aid claims and corrections were submitted. Ensure that all outstanding invoices are sent as soon as possible to patients.
	Operational Role: Check all billed stock and ensure all used stock is billed. Mark all stock items that will not be charged as non-chargeable. Check that used non-chargeable items are billed to patient accounts or a non-chargeable account. Check that the correct item, strength and pack size were used with the billing. Confirm that the cost of sales has been calculated and is accurate. Ensure there are stock to be billed and all supplier invoices are up to date.
	Operational Role: Ensure that billing was done correctly and balances with the Audit Trail. Ensure that VAT calculations are correct.
	Action maps: Collection stage: Information quality Communication to DS Compliance continuity: Confidentiality measures

Purpose of Billing

Billing is equal to Income (money). Billing is the only way to generate income for the procedures that were done or stock that was used or sold. Billing ensures that timely, accurate and complete accounts are submitted to medical aids or issued to private patients.

Billing ensures income into the practice to pay accounts and salaries. Patients need to be billed to get income into the practice. Without income, the practice will come insolvent. A practice stays a business that needs income to be able to keep on treating patients.

The billing chapter will be divided into the following sections:

Optimisation of Turnover in your practice
Tariffs and Terminology
Medical codes and Rules
Billing Business Processes

Billing vs coding

Medical billing and coding are the backbones of the healthcare revenue cycle, ensuring Medical Schemes, Insurers, and patients reimburse providers for services delivered. Medical billing and coding translate a patient encounter into the language of claims submission and reimbursement.

Billing and coding are separate processes, but both are crucial to receiving payment for healthcare services. Medical coding involves extracting billable information from the medical record and clinical documentation, while medical billing uses those codes to create claims and bills for patients. Creating claims is where medical billing and coding intersect to form the backbone of the healthcare revenue cycle.

The process starts with patient registration and ends when the provider receives full payment for all services delivered to patients.

◄ Previous: 8.8. Clinical History & Reports Next: 9.1. Different Practice Type & Optimisation of Turnover ►