Health Medical Homework Help

In the attached article from Health Affairs, a medical student documented her on-going dealings with a physician’s office and a health insurance company. The student had broken both her arms when she fell while jogging. In the article, the student identifies problems that occurred in the claims process and also her own lack of knowledge regarding billing rules. After reading the article, discuss one problem either from the provider’s, the insurance, or the student’s perspective that is mentioned. Please try to come up with a different problem or issue from the other group members. As an HIM professional how would you be able to remedy the identified problem if at all?

When coming up with solutions, keep in mind that HIM professionals are often involved in resolving questions about claims or bills when working in various settings. This is especially true when working either in the hospital coding department or in a physician’s office. Our job is to be able to look up the coding guidelines, talk with the physician(s), read the medical record and help out the patient or work with another department that contacts the patient or insurance company directly. HIM professionals also work for insurance companies. I have talked to patients numerous times and have certainly seen both sides of the fence! My last point is that sometimes, the physician is incorrect and as a result, we also play the role af educators while other times, we must educate the patient (hope these suggestions help).

One last thought…do you think that value based purchasing or a different payment method would remedy any of the problems that this student encountered?