In the world level, the people are emerging new technology in the medical field called outsourced medical billing and coding. Because they can link the patients with hospitals and insurance companies with hospitals as they are interlinked. This should have certain rules and relationships between three people hospital, patient, and insurance company, here the outsourced medical billing company will act as a third party for this three people and a medium to connect them. They will do billing, claim settlement, and saving the medical record.
This company will not involve the process directly, they just provide the software to the hospital in which they record the patient details, the outsourcing company have one set of manpower to do these process and this will be highly confidential within the outsourcing company, they also check with the patient’s insurance company regarding the claim and that insurance company will have an agent to resolve the claim, he will directly visit the hospital and patient to confirm the claim. After the conformation, insurance company process the claim in a package, those insurance company will have a set of package like they will offer some amount for some treatment. The full billing amount will not be given by the insurance company; they just give the sanction of some part of the billing amount. After some hours the claim will be received by the hospital management directly through the outsourced company.
This process is fully digitalized and recorded as perfect proof for the things that happened. If there was an issue, further they proceed with this proof as to the evidence. There are some disadvantages to using this kind of health care system. Some of the disadvantages are given below.
Medical errors- they do billing with the errors in the system this makes a huge problem for the hospital organization and the patient also. Normally, this type of error won’t occur, this will happen very uncertainly as a rare case. But if this happens, to solve the problem is very difficult and it will create a black mark in the outsourcing medical billing industry.
Medical crime- even though this is a digital platform, many flaws are happening in the company like the hospitals are targeting the insured patients alone for the treatment because they will get the money for sure and there won’t be any negotiation. This is purely a crime happening in all the big private hospitals, for this, they have a set of people assigned to fulfil the target. They do marketing with the people and create fear inside the people about the treatment and they prefer big private hospitals for the treatment. Some more crime also happening by giving the wrong report about the patient and getting money from them. For example: if a patient is reaching the hospital for a fever, now some days there is a fear of COVID-19 virus in the world, the hospital uses the important symptoms of fever as a tool. They communicate the patients to take the corona test first and start to quarantine them in their hospital. They use corona fear as an important thing to make money. They charge everything as a huge like using a ventilator and intensive care unit for the corona case as high as a desired amount by the government.