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What Is The Patient’s Responsibility In Medical Billing?

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According to recent studies, around 72% of the American population is confused by their medical bill charges, and 94% of consumers consider their medical bills to be “too expensive”. Even when assisted by insurance companies or Medicare, you may find unexpected balances due to odd procedural codes, a slew of medical terminology, and insurance adjustments.

This guide will help the patients to follow the medical billing and coding process from the moment you contact a healthcare provider for an appointment until after you receive your medical bill in the mail.

  1. Facility capacity:

National Institute for Health Care Management (NIHCM) focus on the factor of Foundation Hospital capacity growth more intensely, since the number of beds in a hospital is the influential fact that describes what hospitals charge under a fee-for-service (FFS) system. As the number of hospital beds is proportional to the greater opportunity to provide certain medical services.

  • Supply and demand: 

Always try to find out the following features in the health care provider facility in your area;

  • Are medical services you need readily available?
  • Are there multiple high capacity hospitals or physicians’ offices in your area can provide your concerned services?
  • Are you accessing just a limited number of medical health care specialists?

Firms with little or no competitive pressure raise the prices of their health care facilities than true medical charges.

  • Hospital reputation: 

A hospital’s reputation has a significant effect on how many patients use a facility, which results in the influences on demand and cost. However, the Agency for Healthcare Research and Quality warns consumers that clinical quality scores contributed less to hospital selection by the patient compared with a hospital’s reputation. This can increase business and influence service costs, but the patient shouldn’t depend upon an apparent reputation as an indication of better performance and good quality.

  • Charge Description Master (CDM) lists: 

This resource is a master list of service costs and billing identifier codes that medical billing professionals use as an insight into the claims process as health offices evaluate how much to bill insurance companies and patients. Each hospital maintains its own distinct charge master list. The American Health Information Management Association (AHIMA) put forward that Charge Description Manager prices should be maintained by charge master committees that administers the duties like reviewing all payments that are charged into dollar amounts for verification of accuracy by the payer.

  • Medical bills and EOBI Statement:

It is important not to confuse your medical bill with the Explanation of Benefits (EOB). It is often observed that whenever patients receive their medical bills from their healthcare providers, the multiple components of that bill are not comprehensive for the patients. As, the codes, descriptions, and prices listed in their bills can seem unclear to them. Healthcare providers use a standardized Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) that can assist the patients to identify the exact services and supplies they received during their appointment.

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