Academic Master

Human Resource And Management

Achieving Maximum Reimbursement


Regardless of the profession, effective documentation and tracking of expenses is fundamental to success. In private practice, this is no exception as this is the only way a practitioner can ensure he keeps track of his expenses (Coe, 2005). It will also ensure that reimbursements are well processed and managed as required. In private practice, an individual can ensure that he does not lose his reimbursements in several ways, the main one being documentation.

Charting and Documentation

Under charting and documentation, a person in private practice will ensure that he maintains an impeccable record of the events and expenses that he incurs for the patient. In this approach, the patient will also be tasked with maintaining the best records and making notes of the costs that should be reimbursed, alongside those that are not due for reimbursement.


Scheduling is the practice that allows a practitioner to plan and keep track f the events and actions that he will undertake in a frequent basis. Under scheduling, an individual will make a note of the expenses that he expects to incur and how to make not of them. In scheduling, a practitioner will also ensure that he expects certain costs to be reimbursed and thus, increased ease of reimbursements.

Diagnosis codes

An understanding of diagnosis codes will also serve to ensure that the practitioner does not lose any monies in reimbursements. Understanding these codes requires that the right amounts and processes are employed for different diagnosis (Loukides & Gkoulalas-Divanis, 2013). This is the best approach that should also be taught and trained to any assistants because they might also contribute to the attaching of poor codes to diagnosis thus, losing reimbursements.

Procedure codes

Similarly, there should be a good understanding of the procedure codes. This means that when compiling reimbursements, the practitioner and nay assistants should be aware of the codes that various procedures fall under, as these codes will also impact the reimbursements due to the practitioner. In instances where a procedure with a high reimbursement potential is not realised or recognised, the practitioner will levy a flat rate reimbursement code which will present an opportunity for lost reimburse nets.

Management Codes

The understanding of management codes will also serve to either reduce or increased the reimbursements due to the practice. This underscores the idea that the practice should be monitored to ensure that the management codes used in the reimbursements requests are accurate and that they are not inflated or wrong. This is under the assumption that the competition practices around the practice are not inflating their costs unnecessarily.

Completion of CMS 1500 and Insurance Claims

Finally, the completion of CMS 1500 and insurance claims is another avenue that will ensure that the practice does not lose any incomes and reimbursements (Schrag, Bach, Dahlman & Warren, 2002). This is an essential avenue that will see that there are no leakages in the claim forms that might amount to lost revenues and reimbursements. The practitioner and the assistants should be keen to ensure that the right processes are followed that might result to lost reimbursements, and similarly, that in filling claim forms, that the right information is used and none is omitted either in error or in by negligence.


Coe, M. (2005). Realizing maximum product revenue utilizing a product revenue model. In Proceedings – 18th International Conference on Systems Engineering, IICSEng 2005 (Vol. 2005, pp. 194–195).

Loukides, G., & Gkoulalas-Divanis, A. (2013). Utility-aware anonymization of diagnosis codes. IEEE Journal of Biomedical and Health Informatics, 17(1), 60–70.

Schrag, D., Bach, P. B., Dahlman, C., & Warren, J. L. (2002). Identifying and measuring hospital characteristics using the SEER-Medicare data and other claims-based sources. Medical Care, 40(8 Suppl), IV-96-103.



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