Health

Growing Importance of Medical Billing and Coding for Value-Based Organizations

Everyone wishes for a happy and healthy life. So, they want financial support that can cover medical expenses in case of illness or injury. That’s why over 80% of the USA population is covered under some insurance scheme.

The USA’s population is getting older daily and is anticipated to double by 2060. However, 68% of them will suffer from two chronic illnesses. This results in increased patient data, which can overwhelm healthcare providers and insurance companies. Healthcare providers submit claims to insurance companies to get payments for their care.

That’s where medical billing and coding come in. Translating the medical services and procedures into the recognized codes is crucial in the reimbursement process. This ensures that healthcare providers get adequately compensated. This blog delves into the importance of medical coding and billing and how it can help value-based organizations.

Medical Billing

Understanding Medical Coding and Billing

Medical coding involves a unique code for each diagnosis and is crucial to insurance reimbursement. Coders translate diagnoses and procedures into the universal HCC code, helping to process the bill correctly to risk adjustment healthcare providers.

Medical billing is a process of documentation, submission, and follow-up on claims, aiding in better-functioning healthcare entities. Medical billing helps insurance companies to provide adequate reimbursement to healthcare providers. Medical offices get reimbursements for services, like Medicare and Medicaid, from private insurance providers. Moreover, it is essential to understand that medical billing and coding are often called entities.

Importance of Medical Coding and Billing

We are pretty clear that medical billing and coding are essential to upkeep healthcare entities. Here are few importance of medical coding and billing:

Efficient Claim Process

Physicians and hospitals need to work with patients all day without a specified framework like medical coding, which is tiresome. They also need to sit and file a claim to the insurance company and wait for their response on reimbursement. On the other hand, medical coding and billing ensure that healthcare entities get accurate reimbursement hassle-free.

Regulatory Compliance in Healthcare

Healthcare entities must comply with the healthcare regulatory body’s stringent rules and regulations. They need to keep a record of treatment and procedure. Moreover, they also provide a wide range of services based on patients’ requirements. It is essential risk adjustment for healthcare providers to have financial stability.

For this, accurate reimbursement is vital for the services. Medical coding and billing ensure the accuracy of money for their service, mitigating the financial strain on healthcare entities.

Patient-Centric Financial Transparency

Patients are unaware of the medical terms, leading to confusion and frustration when understanding medical billing. Medical billing ensures transparency by adding only associated costs. This demonstrates why patients are getting charged, ensuring financial clarity.

Risk Adjustment for Financial Stability

In the end, insurance companies also require standardized processes to process claims efficiently. Medical coding ensures that all services are documented well and insurance companies can understand them easily. This ensures quicker and more accurate claim processing.

Outsourcing medical billing

How Does Medical Coding and Billing Help Value-Based Organizations?

Efficient Resource Allocation

Value-based organizations need to optimize resource allocation to enhance efficiency. Accurate medical coding and billing data enable organizations to identify areas where resources are most needed, leading to better strategic planning and allocation of resources.

Population Health Management

Medical coding is instrumental in population health management, where healthcare organizations proactively manage the health of specific patient groups. Accurate coding facilitates the identification of at-risk patients, allowing organizations to implement targeted interventions to improve outcomes and reduce costs.

Risk Adjustment

Value-based care often involves managing patients with different levels of health risks. Accurate medical coding helps identify and document the severity of illnesses, contributing to appropriate risk adjustment. This ensures that organizations adequately compensate for patients with more complex health needs.

Accurate Reimbursement

Medical coding ensures that healthcare services are accurately documented with specific codes corresponding to diagnoses, procedures, and treatments. This accuracy is vital for proper reimbursement in value-based care models.

Accuracy and Quality

This ensures the quality of service, as accurate billing and coding take care of healthcare organizations’ financial health. This helps them to keep their record highly accurate. Moreover, coding and billing are done under coding guidelines that help organizations to maintain accuracy.

Concluding Remarks on Medical Billing

The growing importance of medical billing and coding in the context of value-based organizations cannot be overstated. As the United States population ages and the prevalence of chronic illnesses rises, the demand for accurate and efficient healthcare reimbursement processes becomes increasingly crucial.

Medical billing and coding are the backbone of this reimbursement system. This translates complex medical services into standardized codes that streamline the billing and claims process.

Health

Report Causes Pfizer Stock to Climb Approximately $1 Billion Acquired by Starboard

(VOR News) – According to a rumor that activist investor Pfizer Starboard Value has taken a holding in the struggling pharmaceutical business that is expected to be worth around one billion dollars, the stock of Pfizer (PFE) is on the increase in premarket trading on Monday.

This comes after the report was made public. The report was made available to the general public following this. Starboard Value was successful in moving forward with the acquisition of the position.

Starboard is said to have approached Ian Read, a former chief executive officer of Pfizer, and Frank D’Amelio, a former chief financial officer, in order to seek assistance with its goals of boosting the performance of the company, according to the Wall Street Journal. Read and D’Amelio are both former Pfizer executives.

The purpose of this is to facilitate the accomplishment of its objectives, which include enhancing the overall performance of the firm.

In their previous jobs, D’Amelio and Read were chief financial officers.

It is stated in the report that the hedge fund is of the opinion that Pfizer, which is currently being managed by Albert Bourla, who succeeded Read as Chief Executive Officer (CEO) in 2019, does not demonstrate the same level of mergers and acquisitions (M&A) discipline that Read did. Bourla took over for Read in 2019. Read was succeeded by Bourla in the year 2019.

Pfizer, a multinational pharmaceutical conglomerate, has made substantial investments in the acquisition of more companies that are involved in the research and development of cancer medicines.

These businesses have been acquired for billions of dollars. The biotechnology company Seagen, which was acquired by Pfizer in the previous year for a price of $43 billion, is included in this category. One of the businesses that can be classified as belonging to this category is Seagen.

In spite of the fact that the S&P 500 Index experienced a 21% increase in 2024.

No major trading occurred in Pfizer stock that year.

Due to the fact that the demand for Pfizer’s COVID-19 vaccines fell after the firm reached its pandemic peak in 2021, the share price of the corporation has decreased by over fifty percent since that time.

This drop has occurred ever since the company’s shares reached their maximum peak, which was during the time that this decline occurred. Not only have they not changed at all, but they have also remained essentially stable. This is in contrast to the S&P 500, which has gained 21% since the beginning of this year.

Recently, the corporation was forced to take a hit when it decided to recall all of the sickle cell illness medications that it had distributed all over the world.

Fears that the prescription could lead patients to experience severe agony and possibly even death were the impetus for the decision to recall the product. In spite of the fact that Pfizer’s stock is increasing by almost three percent as a result of the news that followed the company’s decision, this is the circumstance that has come about.

SOURCE: IPN

Health

New Study Reveals Drinking Soda Pop Increases the Risk of Stroke

If you drink too much soda, fruit juice and coffee, beware!

A recent report from global research indicates that excessive consumption of coffee or soda pop is associated with an increased risk of stroke, although the intake of black and green tea is correlated with a reduced risk. Excessive consumption of soda pop or coffee warrants caution!

Recent research indicates that it may substantially elevate the risk of stroke.

Consuming four cups of coffee daily elevates the risk of stroke, according to studies, although ingesting 3-4 cups of black or green tea daily typically offers protection against stroke. Additionally, consume more coffee; it may reduce your risk of mortality.

Recent findings from global research studies co-led by the University of Galway and McMaster University, alongside an international consortium of stroke researchers, indicate that soda, encompassing both sugar-sweetened and artificially sweetened variants such as diet or zero sugar, is associated with a 22 percent heightened risk of stroke. The risk escalated significantly with the consumption of two or more of these beverages daily.

Stroke Risk Fizzy Drinks and Soda Pop

The correlation between fizzy drinks consumption and stroke risk was most pronounced in Europe, the Middle East, Africa, and South America. Women exhibit the most elevated risk of stroke from bleeding (intracranial hemorrhage) associated with fruit juice beverages. Consuming over 7 cups of water daily diminishes the likelihood of stroke due to a clot.

Researchers observed that numerous items advertised as fruit juice are derived from concentrates and have added sugars and preservatives, potentially negating the advantages often associated with fresh fruit and instead elevating stroke risk.

Fruit juice beverages were associated with a 37 percent heightened risk of stroke resulting from bleeding (intracranial hemorrhage). Consuming two of these beverages daily increases the risk thrice.

Consuming over four cups of coffee daily elevates the risk of stroke by 37 percent, although lower consumption levels do not correlate with stroke risk. Conversely, tea consumption was associated with an 18-20 percent reduction in stroke risk. Additionally, consuming 3-4 cups daily of black tea, such as Breakfast and Earl Grey varieties, excluding green and herbal teas, was associated with a 29 percent reduced risk of stroke.

Consuming 3-4 cups of green tea daily was associated with a 27 percent reduction in stroke risk. Notably, the addition of milk may diminish or inhibit the advantageous effects of antioxidants present in tea. The lower risk of stroke associated with tea consumption was negated for individuals who added milk.

Disclaimer: This article is intended solely for informational reasons and should not be considered a replacement for professional medical counsel. Consistently consult your physician regarding any inquiries pertaining to a medical problem.

Starbucks Faces Sales Decline Amid Price Fatigue and Rising Competition

Starbucks Faces Sales Decline Amid Price Fatigue and Rising Competition

Health

Following a Diagnosis of Breast Cancer, What Else Should You Know?

(VOR News) – Even though breast cancer affects one in eight American women, receiving a diagnosis can make a woman feel isolated.

Experts in breast cancer from the American College of Physicians (ACS) advise patients on how to manage their disease so that they may better cope with this awful information.

First, the kind and stage of breast cancer dictates the course of your care.

In addition to immunotherapy and chemotherapy, there are various surgical options available for the treatment of breast cancer.

Women of African descent are disproportionately affected by triple-negative breast cancer, an extremely aggressive form of the disease that has never proven easy to treat.

According to the American Cancer Society, pembrolizumab (Keytruda), an immunotherapy, has been shown to be helpful when combined with chemotherapy and is currently the recommended course of treatment for certain combinations of triple-negative breast cancer.

In her presentation, Dr. Katharine Yao said, “It’s really important that the patient and physician discuss the patient’s preferences and values when deciding what type of treatment to pursue and that they have an honest, individualized discussion with their care team.”

She is currently responsible for developing breast cancer treatment recommendations for more than 575 hospitals and institutions nationwide in her role as chair of the American College of Surgeons’ National Accreditation Program for Breast Institutions (NAPBC).

Yao, vice chair of research at Endeavor Health NorthShore Hospitals in New York, pointed out that each decision made about a patient’s treatment plan should take her preferences and diagnosis into consideration.

She ought to think about whether she would prefer a mastectomy—a surgical procedure that involves removing the entire breast with or without reconstruction—or a lumpectomy, which involves a surgical procedure that spares part of the breast tissue.

She stated that “the breast cancer you have may be very different from the breast cancer you hear about in your neighbor, colleague, or friend” in a press release issued by the American Cancer Society (ACS).

“Consider that while discussing breast cancer with others.”

Throughout your journey, it is critical that you look after your emotional health because having breast cancer may have a detrimental impact on your mental health.

“Getting a cancer diagnosis does not mean that everything in your life stops to be normal.” Director of the Fellowship in the Diseases of the Breast program at the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas and state head of the American Cancer Society Commission on Cancer for Arkansas, Dr. Daniela Ochoa She thinks adding the burden of a cancer diagnosis and treatment to all the other pressures in life may be taxing.

“Managing stress and emotional health is vital component of a treatment plan.”

Ochoa recommends clinically trained psychologists and social workers who have assisted people in coping with cancer to anyone receiving treatment. Learning coping techniques might also be facilitated by joining cancer support groups or cancer wellness initiatives.

Breast cancer specialists say your care team is crucial.

The American Cancer Society (ACS) defines comprehensive care as having support at every stage of the procedure from surgeons, oncologists, patient navigators, nurses, social workers, psychologists, and other specialists.

After receiving a breast cancer diagnosis, women should see a surgeon or medical oncologist to explore their options; nevertheless, treatment shouldn’t be discontinued after just one appointment or after surgery is over.

Additionally, you can ask trustworthy friends or family members to accompany you to appointments and aid you with research or notes. They could serve as a network of support for you.

Yao stated in his talk that “one of the most important things is that patients should search out a team they have confidence in, that they trust will have their back when they need it, and a team they feel they can get access to and that will help them when they are in need.”

SOURCE: MP