Journal: Payment Systems

4-2 Journal: Payment Systems
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HCM 345 J
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Compare and contrast the various billing and coding regulations researched in Module Two to determine which ones apply to prospective payment systems. Reflect on how these regulations affect reimbursement in a healthcare organization. Assess the impact of regulations on reimbursement in a healthcare organization and explain what you think is working and what could be a challenge. If possible, bring in a real-world example either from your life or from something you have read about.The previous order you did for this client is - 00127672, (2-1 Journal: Compliance, Coding, and Reimbursement).
Health Insurance Portability and Accountability Act (HIPAA) medical codes useful in billing and coding provide clarity on what to use. Providers and billers submit claims electronically and are required to follow the codes and approved format. Title II and Medical Billing of HIPAA required a national standard for electronic medical transactions and specific identifiers for the providers, employers, and insurers as part of preventing health care fraud and abuse. Entities not covered by HIPAA are expected to adopt ICD-10 for patient billing and coding. The Prospective Payment Systems (PPS) is a reimbursement method that determines Medicare payment considering the classifications for services such as diagnosis. It also highlights that there is hospital reimbursement based on the Diagnosis Related Groups (DRGs). The PPS also has billing and coding retirements, which distinguishes the outpatient PPS and inpatient PPS. Like the HIPA, the PPS highlights the need to access data that is accurate and c...