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HCA 240 Biller:Benefits Coordinator Interview.
Jessika Steiniger
HCA-240
November 16, 2019
Steve Klense
Biller/Benefits Coordinator Interview
Billing is a huge part of an organization, even when it comes to the military where most
things are fully covered by insurance. There are certain things that must be done to make sure
the insurance covers the costs. There are differences when it comes to paying with cash, third
party insurance, or Medicare/Medicaid, difference in how charging happens, and how private
and government insurers impact reimbursement.
The billing process in healthcare depends on if the patient has insurance and the type of
insurance coverage (MB-Guide.org Website, 2014). The patient can either pay cash, have
private insurance, or have Medicare/Medicaid. Private insurance is insurance you buy directly
form a health insurance company. Medicare is a federally funded program for adults over 65 and
Medicaid is run by state and federal governments and covers those with low income. Tricare is
the health insurance provided to military members and their families (Glover, 2016). Billing
through these insurances are almost the same. Claims are sent to insurers only since Medicare
and Medicaid are government programs, the claims are sent directly to them. Medicare has
different guidelines for billing depending on if the patient has part A, B, C, or D. Parts A and B
are the same as billing for private and third-party insurers. The patient information and all codes
are entered and then claim is sent. Parts C and D get more complicated. Part C is a private
insurance plan and billers are not allowed to bill for services provided to patients with this
This study source was downloaded by 100000817936687 from CourseHero.com on 02-04-2022 07:17:30 GMT -06:00
https://www.coursehero.com/file/51924990/BillerBenefits-Coordinator-Interviewdocx/
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coverage. Part D can only be billed by those licensed to bill for this part (Everything You need
to get started in medical billing & coding, n.d.).
When it comes to charging and pricing of healthcare, there are a few different ways this
can go about. There is payment basis, which the payer determines the amount to be paid, fee
scheduled basis which is a predetermined cost, price related payment basis where the provider is
paid based on total charges, and bundled services meaning an amount is set and charged per day
the patient is there (Cleverley, Song, Cleverley, 2011). Pricing for healthcare is done by a
process called price setting. This is a list of services provided and their prices. If the patient has
Medicare or Medicaid, then this list does not make a difference since they have a fixed-fee-
schedule basis. Since insurance may not pay for all of the service, the patient may have to cover
some of the payment from the service provided. Unlike with other industries where someone can
be turned away based on bad credit or a history of not paying their bill to that industry, a hospital
cannot turn patients away or deny care. In healthcare it does not matter the credit score of the
patient, someone cannot be denied treatment.
Once a service is provided a bill is then sent to the insurance company that patient has
and the reimbursement process is started. If the patient has Medicare then there is a set amount
that is reimbursed whereas with private insurance the company usually has their own agreed
upon rates with the healthcare organization. To be reimbursed properly the organization must
make sure that their coding is correct. If not then the coding that was missed will not be covered
(Beck, and Margolin, 2007).
To help understand some of the billing process Angela Macintyre, who works at the
dental clinic on Hill Air Force Base in Utah was interviewed. She is in charge of checking what
benefits the patient has and making sure the referral process is done correctly. Angela (personal
This study source was downloaded by 100000817936687 from CourseHero.com on 02-04-2022 07:17:30 GMT -06:00
https://www.coursehero.com/file/51924990/BillerBenefits-Coordinator-Interviewdocx/
HCA 240 Biller:Benefits Coordinator Interview.
Jessika Steiniger
HCA-240
November 16, 2019
Steve Klense
Biller/Benefits Coordinator Interview
Billing is a huge part of an organization, even when it comes to the military where most
things are fully covered by insurance. There are certain things that must be done to make sure
the insurance covers the costs. There are differences when it comes to paying with cash, third
party insurance, or Medicare/Medicaid, difference in how charging happens, and how private
and government insurers impact reimbursement.
The billing process in healthcare depends on if the patient has insurance and the type of
insurance coverage (MB-Guide.org Website, 2014). The patient can either pay cash, have
private insurance, or have Medicare/Medicaid. Private insurance is insurance you buy directly
form a health insurance company. Medicare is a federally funded program for adults over 65 and
Medicaid is run by state and federal governments and covers those with low income. Tricare is
the health insurance provided to military members and their families (Glover, 2016). Billing
through these insurances are almost the same. Claims are sent to insurers only since Medicare
and Medicaid are government programs, the claims are sent directly to them. Medicare has
different guidelines for billing depending on if the patient has part A, B, C, or D. Parts A and B
are the same as billing for private and third-party insurers. The patient information and all codes
are entered and then claim is sent. Parts C and D get more complicated. Part C is a private
insurance plan and billers are not allowed to bill for services provided to patients with this
This study source was downloaded by 100000817936687 from CourseHero.com on 02-04-2022 07:17:30 GMT -06:00
https://www.coursehero.com/file/51924990/BillerBenefits-Coordinator-Interviewdocx/
, 2
coverage. Part D can only be billed by those licensed to bill for this part (Everything You need
to get started in medical billing & coding, n.d.).
When it comes to charging and pricing of healthcare, there are a few different ways this
can go about. There is payment basis, which the payer determines the amount to be paid, fee
scheduled basis which is a predetermined cost, price related payment basis where the provider is
paid based on total charges, and bundled services meaning an amount is set and charged per day
the patient is there (Cleverley, Song, Cleverley, 2011). Pricing for healthcare is done by a
process called price setting. This is a list of services provided and their prices. If the patient has
Medicare or Medicaid, then this list does not make a difference since they have a fixed-fee-
schedule basis. Since insurance may not pay for all of the service, the patient may have to cover
some of the payment from the service provided. Unlike with other industries where someone can
be turned away based on bad credit or a history of not paying their bill to that industry, a hospital
cannot turn patients away or deny care. In healthcare it does not matter the credit score of the
patient, someone cannot be denied treatment.
Once a service is provided a bill is then sent to the insurance company that patient has
and the reimbursement process is started. If the patient has Medicare then there is a set amount
that is reimbursed whereas with private insurance the company usually has their own agreed
upon rates with the healthcare organization. To be reimbursed properly the organization must
make sure that their coding is correct. If not then the coding that was missed will not be covered
(Beck, and Margolin, 2007).
To help understand some of the billing process Angela Macintyre, who works at the
dental clinic on Hill Air Force Base in Utah was interviewed. She is in charge of checking what
benefits the patient has and making sure the referral process is done correctly. Angela (personal
This study source was downloaded by 100000817936687 from CourseHero.com on 02-04-2022 07:17:30 GMT -06:00
https://www.coursehero.com/file/51924990/BillerBenefits-Coordinator-Interviewdocx/
