Research three billing and coding regulations that impact healthcare organizations. Reflect on how
these regulations affect reimbursement in a healthcare organization. Comment on what seems to
work well and what could be improved. If possible, bring in a real-world example either from your life
or from something you have read about.
Healthcare Reimbursement Chapter 2 journal entry
Research three billing and coding regulations that impact healthcare organizations. Reflect on how these
regulations affect reimbursement in a healthcare organization. Comment on what seems to work well
and what could be improved. If possible, bring in a real-world example either from your life or from
something you have read about.
The healthcare industry is a business. Although healthcare professionals operate in a capacity to
improve the overall health of the community, financial support and backing continues to be a major
concern. Healthcare organizations must receive reimbursement for the services they provide. Billing
and coding regulations are put in place to ensure that each healthcare organization adheres to the same
standard.
1. The first regulation which is at the forefront of healthcare billing, coding, and privacy is the Health
Insurance Portability and Accountability Act (HIPAA) of 1966. “With the Administrative Simplification,
Title II established a set of regulations and guidelines for the electronic transmission of healthcare data,
and sets up guidelines for the code sets used in medical billing and coding” (HIPAA 101 p. 1). The HIPAA
regulation formalized every code used in the healthcare setting. The codes which are designated for use
are the ICD-9-CM, ICD-10-CM, CPT codes, and HCPCS codes. National Provider Identifiers (NPIs) must
also be used in the submission of claims. (Harrington 2016, p. 192-198). HIPAA established these
policies and guidelines to ensure communication from every entity within a healthcare organization is
being accomplished. By creating these policies, HIPAA has helped to create an operating standard which
is paramount in claims. Claim forms as well as other supporting medical documentation must be
submitted electronically. If documentation isn’t completed appropriately, claim submission may be
delayed. Healthcare organizations that do not accurately document patient care, may not be
reimbursed for services rendered. These organizations are held accountable for the information
documented in the claims form. Medical professionals who code diagnosis incorrectly, can face criminal
charges. This is considered fraud and not to be tolerated by any healthcare organization. I believe that
this regulation has been working well in the Army medicine department. Every provider and medical
professional includes a HIPAA clause in every single email which is sent from government computers.
This notice helps to ensure that only persons with need to know capacity use the information for
purposes intended.
2. Another organization which plays an important role in the billing and coding system is the Health
Care Reform Act of 2010. Healthcare eligibility is growing and as a result the amount of claims are a
direct reflection of this growth. Healthcare billing and coding representatives are in great demand since
the law was passed. “The Healthcare Reform Act is designed to increase healthcare access, including to
those people who should already have access to care under current federal healthcare laws” (Medical
billing p.1). The most important tool available to increase healthcare access is the electronic medical
record (EMR). The goal of implementing the EMR system is to help ease the burden associated with
administrative duties related to billing and coding. These laws have helped providers, healthcare
professionals, and payers work together to create a cohesive process. According to Terry (2012), 72%
these regulations affect reimbursement in a healthcare organization. Comment on what seems to
work well and what could be improved. If possible, bring in a real-world example either from your life
or from something you have read about.
Healthcare Reimbursement Chapter 2 journal entry
Research three billing and coding regulations that impact healthcare organizations. Reflect on how these
regulations affect reimbursement in a healthcare organization. Comment on what seems to work well
and what could be improved. If possible, bring in a real-world example either from your life or from
something you have read about.
The healthcare industry is a business. Although healthcare professionals operate in a capacity to
improve the overall health of the community, financial support and backing continues to be a major
concern. Healthcare organizations must receive reimbursement for the services they provide. Billing
and coding regulations are put in place to ensure that each healthcare organization adheres to the same
standard.
1. The first regulation which is at the forefront of healthcare billing, coding, and privacy is the Health
Insurance Portability and Accountability Act (HIPAA) of 1966. “With the Administrative Simplification,
Title II established a set of regulations and guidelines for the electronic transmission of healthcare data,
and sets up guidelines for the code sets used in medical billing and coding” (HIPAA 101 p. 1). The HIPAA
regulation formalized every code used in the healthcare setting. The codes which are designated for use
are the ICD-9-CM, ICD-10-CM, CPT codes, and HCPCS codes. National Provider Identifiers (NPIs) must
also be used in the submission of claims. (Harrington 2016, p. 192-198). HIPAA established these
policies and guidelines to ensure communication from every entity within a healthcare organization is
being accomplished. By creating these policies, HIPAA has helped to create an operating standard which
is paramount in claims. Claim forms as well as other supporting medical documentation must be
submitted electronically. If documentation isn’t completed appropriately, claim submission may be
delayed. Healthcare organizations that do not accurately document patient care, may not be
reimbursed for services rendered. These organizations are held accountable for the information
documented in the claims form. Medical professionals who code diagnosis incorrectly, can face criminal
charges. This is considered fraud and not to be tolerated by any healthcare organization. I believe that
this regulation has been working well in the Army medicine department. Every provider and medical
professional includes a HIPAA clause in every single email which is sent from government computers.
This notice helps to ensure that only persons with need to know capacity use the information for
purposes intended.
2. Another organization which plays an important role in the billing and coding system is the Health
Care Reform Act of 2010. Healthcare eligibility is growing and as a result the amount of claims are a
direct reflection of this growth. Healthcare billing and coding representatives are in great demand since
the law was passed. “The Healthcare Reform Act is designed to increase healthcare access, including to
those people who should already have access to care under current federal healthcare laws” (Medical
billing p.1). The most important tool available to increase healthcare access is the electronic medical
record (EMR). The goal of implementing the EMR system is to help ease the burden associated with
administrative duties related to billing and coding. These laws have helped providers, healthcare
professionals, and payers work together to create a cohesive process. According to Terry (2012), 72%
