Healthcare Billing Process (Interview)

Healthcare Billing Process (Interview)

In the contemporary world, different industries or sectors have almost the same type of charging and pricing process. However, healthcare sector is an exception since its focus is not on profit as the other industries but on consumer satisfaction, which is partly due to cost-effectiveness. As such, based on this example, it is beyond doubt that the healthcare billing process will always differ with other industries. In essence, this paper aims at establishing the practical details of the healthcare billing process by interviewing a healthcare facility coder/biller. At the heart of this interview are two central themes that are worth noting. They include an in-depth analysis of the differences between charging and pricing processes in healthcare and other industries as well as the impact of private and government insurers and payers on reimbursement. By so doing, attainment of new knowledge and deeper insight about this issue is inevitable.

Healthcare Charging and Pricing Processes (Differences)

Primarily, from the interview of the healthcare facility biller, charging and pricing process medicalsector differs from other industries in a variety of ways that are worth highlighting. A befitting example of such differences is apparent in the model of pricing where in most case healthcare prices is more of a cost-shared expense as compared to commodities from other industries with fixed prices (DeMarco, 2012).

Additionally, healthcareis an intangible product, whose pricing transparency is not easy. That is for sure since measurement of healthcare size is not possible like tangible products, which one will pay a predetermined and fixed amount of money that is commensurate to the product valuation. Instead, the pricing of healthcare services is on the grounds of multiple variables that include but not limited to the quality of services provided, length of hospital stay and number of investigations conducted. Besides, healthcare facilities face different government regulations, rely on physicians not contracted permanently,and third-party payers coverage, which cumulatively makes the healthcare price of one hospital to differ from another facility.As such, pricing transparency is not possible in healthcare given such differences in medical facilities (DeMarco, 2012).

Impact of Private and Government Insurers and Payers on Reimbursement

Concisely, reimbursement for healthcare services and items offered by a hospital is mainly achievable by patients, insurance carriers and government initiatives. The private of insurance companies significantly depend on premiums paid by employers or employees to cover the healthcare pricing. On the contrary, government initiatives such as Medicare reimburse participating hospital depending on the performance of these facilities. Precisely, the impact of these insurers on reimbursement is an increased amount of funds reimbursed to participating hospitals for good performance. However, poorly performing hospitals are liable to fines and penalties in the Medicare arrangement (Carey, & Lin, 2016).


In closure, this paper aimed at presenting an in-depth analysis of the differences between charging and pricing processes in healthcare and other industries as well as the impact of private and government insurers and payers on reimbursement based on an interview of a healthcare facility coder/biller. Precisely, the discussion has achieved these objectives comprehensively and several deductions are attainable from the same. A case in point of such deductions is the need for a review of this billing process for healthcare organizations aspiring to benefit from insurance companies. In the absence of such consideration, however, the healthcare facilities may end up crumbling down, which is not good for business. Notwithstanding,there is a need for newly founded healthcare organizations to set their priorities right like providing quality healthcare services to consumers of health instead of profit-making if they are to remain viable for the unforeseeable future.




Carey, K., & Lin, M. (2016). Hospital Readmissions Reduction Program: Safety-Net Hospitals Show Improvement, Modifications To Penalty Formula Still Needed. Health Affairs, 35(10), 1918-1923. doi:10.1377/hlthaff.2016.0537

DeMarco, W. J. (2012). Performance-based medicine: Creating the high performance network to optimize managed care relationships. New York: Productivity Press.


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