Medical billing and changing health care

Last week, Health Leaders posted an article from Kaiser Health addressing the new medicine model: healthcare in retail. Wal-Mart is looking at how to incorporate general care into their retail centers. Wal-Mart previously changed the game by adding $4 generic prescriptions to their pharmacies; now by adding physicians, how will this change the medical industry? Wal-Mart aims to be the largest provider of general health physicians in the United States. Walgreens, the article pointed out, already has partnered with CVS Caremark to provide services to diabetic patients. What does this mean for changing health care?

It means that those companies like Wal-Mart and Walgreens are aiming to provide a service based on a business, providing low-cost alternatives to seeing a regular physician. It also means it will change how people view doctors and specialists. One area that customers liked about general care at these box stores is that they knew the price of the service before seeing the doctor. But a worry is that with this system, the patients that use these services are the healthiest patients who do not want to have to get expensive insurance for a yearly head cold or mild asthma. Those patients who require chronic care would still require a general physician, but without reimbursement or an increase in pay to offset costs. If this does occur, this will change the healthcare system again for how and when costs are incurred. Medical billing isn’t just about making sure that bills are paid on time. It is also an effective way to offer patients a safety net by ensuring that they are being billed for procedures that are related to their conditions. Physicians that are routinely performing procedures outside of the norm are caught by the series of checks and balances that medical billing provides. Regulating retail care with a different set of rules and one fee for a procedure prior to service provides a different complex road to navigate.

Due to the implementation of Electronic Health Records in 2012, medical billing will most likely be tasked to medical coders and billers rather than the physician, who adds another check and balance system. Medical billers are responsible also for things making sense- there is more than one story of a mistake in the health care arena due to poorly managed health care records. Good medical billers see through those inconsistencies and ensure proper diagnosis codes.

One concern of moving to a Wal-Mart system is maintaining good health records. Big-box stores may not be ready to handle the complexity of health care issues, as it is more complicated than just offering simple care. Right now, they have contracted using an EMR software so they can develop a Personal Health Record for all patients using Wal-Mart’s system. However, good quality care is more than software; large companies have more room for errors and maintenance. The next several years in health care will be exciting to see how the developments today change the way we look at healthcare tomorrow. Medical billing will continue to be an important factor for maintaining health records in the United States.

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