Effects on Healthcare Reimbursement. Health, Medicine, Coursework

Effects on Healthcare Reimbursement
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Effects on Healthcare Reimbursement
Healthcare reimbursement employs various mechanisms that vary regarding the degree of efficiency. Regardless of the mechanism adopted, it is important for the reimbursement system to remunerate based on the complexity, quantity, and quality of care delivered. The use of current and emerging technologies in monitoring the practice of providers, healthcare functioning, and patient outcomes, has a significant impact on enhancing accuracy and effectiveness of reimbursement process and the overall quality of care (Britton, 2015). This paper discusses the Health Insurance Portability and Accountability Act (HIPAA) Transaction and Code Set standards and Electronic Health Record (EHR) Regulatory Relief Act and how they affect coders and check the process of reimbursement. There will be a discussion on how emerging technology is evaluated in the reimbursement process and the way it impacts the future of reimbursement. Finally, the paper will provide an overview of the current or emerging technology used by healthcare organizations to minimize fraud and abuse through interoperability, remote access, security features, and system requirements.
HIPAA Transaction and Code Set Standards and Coders and Reimbursement
HIPAA transactions and code set standards to refer to regulations that serve to standardize the process of exchange of information related to the identity and health of patients. These standards rely on electronic data interchange (EDI) that permit information exchange from one computer to another without involving humans (Kibbe, 2001). These standards cut across all practices in healthcare organizations, regardless of whether paper or electronic submissions are involved. Coders are required to revert to using these standards in compliance with HIPAA when dealing with insurance plans, clearinghouses, payers and health plans. Under these standards, physicians do not receive their reimbursements from the payers through electronic fund transfer (EFT) systems. However, payers such as Medicare may require providers to be reimbursed through EFT (American Medical Association, 2016).
EHR Regulatory Act and Reimbursement
Another regulation besides HPAA that impacts reimbursement is the EHR Regulatory Act. The Act requires that the Centers for Medicare & Medicaid Services (CMS) to come up with a performance period of 90 days with the purpose of determining if an eligible hospital or provider is qualified user of EHR. Also, the Act requires that CMS take into considerations the Government Accountability Office’s specified results and recommendations to evaluate if the provider and hospital are compliant with EHR (Congress.gov, 2017). In this regard, EHR Act affects reimbursement as Medicaid Eligible Professionals (EP) also providing care to Medicare patients will need to have adjustments to their payment to Medicare reimbursements in case they do not portray any meaningful use (CMS.gov 2018).
Evaluation of Emerging Reimbursement Technology
The United States spending on healthcare has been on the increase since the introduction of Medicare in 1965. With healthcare spending ...