Author: Deeksha Gaikwad
Healthcare system, ICD code-10, Claims, Insurance, IRDAI, Medical coders.
Medical billing is the way of delivering health care claims, which are provided to insurance companies for gaining pay for the medical services provided by the organization.
The medical coders usually extract the billable information and translate them into standardized code which is further passed down to the medical biller and then made into bills and claims which translate, the health care services into medical billing claims to get the reimbursement for the health care services provided.
JOB OF MEDICAL BILLER:
The medical biller interprets the insurance coverage of patients and prepares the accurate claim. The diagnosis and procedure codes prepared by the medical coder both are used in the claim. The codes are of two types:
When we talk about medical billing, medical coding always comes into the picture.
It is part of medical billing, where the medical coder provides codes from the surgical procedure and carry out medical chart audits when the claim is denied. “Medical coding and medical billing are the backbones of the health care system. It makes sure repayment of the services that is provided by healthcare to patients.”
The medical process is a complex process and faces challenges in the healthcare domain. Each step has its own significance and is to be performed by specialists efficiently.
The billing process follows this flow:
Traditionally the billing process was done on paper and was manually entered, but now it is done by means of computers and medical billing applications which has made a large impact from the past to till date and can be done by using more advanced technology in the future. The significance of medical billing by using computer –
In the Indian scenario of the medical billing process is done in two ways, one through cash payment and the other through health insurance. According to the Insurance Regulatory and Development Authority of India [IRDAI] total out-of-pocket medical expenses are nearly 62% of total healthcare costs in India.
Facilities by Government:
The insurance coverage available to Indians is provided by the government at a low cost through schemes like “Ayushman Bharat”.
The expenses of treatment are lower than that of other countries.
The claims submission are done manually or electronically and it takes a lot of manpower.
Responsibilities of patients:
If the person carries healthcare insurance they may not require to pay through their pockets.
From the above, we can conclude that the lack of a proper medical billing system is needed to be established with proper knowledge of healthcare expenditure. Improving the infrastructure of the healthcare system and also making people aware of the importance of the healthcare system and encouraging people for making their career in medical billing and coding process.
GLOBAL BILLING SYSTEM:
In countries like the United Kingdom, United State the individual spends only about 20% of cash on health care families. The insurance coverage is usually provided by private insurance than the government. The billing process in the U.S. is not the doctor’s responsibility. The insurance doesn’t cover all the treatments and procedures. The process of submitting and processing claims is done electronically and patients are often responsible for paying part of their medical bills.
COMPARISONS OF COUNTRIES BASED ON THE APPLICATION OF ICD CODE -10:
Canada: When Canada implemented ICD code 10 it failed as the healthcare system neglected the following:
Underestimation of serious things can be risky. ICD code 10 in Canada did not change coding practice.
India: When India implemented ICD code 10 in October 2015 it brought significant improvement in patient care.
Australia: Australia started using ICD-10 to report mortality rates in 1994.
Having proper information for providers, and patients have led to successful implementation.
FUTURE PROSPECTS OF MEDICAL BILLING IN INDIA:
Medical billing in India has a great future as it is the pub of many uprising services. According to the bureau of labor and statistics the medical field is expected to grow 15% from now to 2024. As technology will be advancing the medical billing process will also be advancing in a positive way. As the implementation of artificial intelligence in the medical billing process it is going to ensure a secure process, no leak of information, and can also give the ultimate joy of error-free data.
India needs to take steps to improve its infrastructure. And education about medical billing is an effective measure to be taken for improvement. Encouraging individuals to establish themselves in the field and also improving the insurance claiming system. Making people aware of the government schemes related to insurance and investing in them can increase life expectancy and make India reach the goal of “DIGITAL BHARAT”.
Overall we can conclude medical billing process is a complex and time-consuming one. To establish oneself in this field, one has to be skilled, and knowledgeable.
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