Reimbursement Ethics and Compliance: Impact of Health Care Reform on Medical Coding and Billing
"Medical billing and coding lays the foundation for any successful healthcare provider," yet its common practices are undergoing significant changes under the recent proposal for health care reform (Griffey, 2013). The nature of medical coding and billing is increasingly becoming more and more complicated. The recent healthcare reform legislation, passed in 2010, promises to complicate the situation even further. Such reforms will undoubtedly have a huge impact on medical billing and coding processes.
The reform bill was a monumental piece of legislation passed by Pres. Obama and his Democratic supporters in 2010. There are a number of stipulations which aim to help increase access to appropriate health care for millions of Americans who are currently without any coverage, helping lower the cost of premiums too much more affordable rate for most Americans but also increasing the coverage of Medicaid and Medicare. Additionally, the statutes presented in the Health Care Reform Bill would essentially help "reduce the deficit by $143 billion over the first ten years" (Jackson & Nolen, 2010). Most significantly, the reform is helping put a stop to insurance companies denying coverage for those individuals who have a pre-existing condition. This is a huge move, one which will help stop some of the discriminatory practices currently commonplace within the healthcare insurance industry. However, it is an incredibly costly endeavor, at a price tag of about $940 billion over the span of ten years (Jackson & Nolen, 2010). The reform will undoubtedly impact a number of areas within the healthcare industry, including medical billing and coding. The final components of the healthcare reform laws are set to begin in the start of 2014.
The nature of medical billing has been changing dramatically in recent years. Medical billing previously used ICD-9 as the standard for coding medical reimbursements. Yet, this has morphed into a new process which is being taught by most school today, which uses ICD-10. According to the research, "with over five times as many codes, going from 13,000 to 68,000, the...
Introduction The main objective of this assignment is to conduct a SWOT analysis for a healthcare organization. Essentially, SWOT analysis is a beneficial framework for scrutinizing an organization’s strengths and weaknesses, and the opportunities and threats experienced. It is beneficial in being aware of the weaknesses and emphasizing on the strengths, alleviating threats, and capitalizing on the opportunities accessible. SWOT analysis lays emphasis on the internal factors of an environment, which
Healthcare Integrity is a major issue for healthcare organizations because there are many avenues for fraud, and for people to demonstrate a lack of ethics. The problem is that the temptation is sometimes too great and despite the fact that there are laws in place to guard against these practices unethical behavior takes place anyway. The government, which supplies a lot of the money which goes for treatments through Medicare and
Healthcare Fraud Identity theft and fraud of many types and forms are obviously a major inconvenience and hindrance to anyone that falls prey to a person that engages that crime. There are many variants and forms of fraud and identity theft out there. One of the more insidious and nasty examples of those crimes would be that which relates to healthcare. Indeed, to have people's wallet, healthcare and the taxpayer dollar
1 Introduction 1.1 Statement of the Problem Lack of health coverage has been a prevalent issue in the United States. Research indicates that in the second year consecutively, there was an increase in the number of uninsured people. Insurance coverage and Medicaid are advantageous and comprehensive programs. However, numerous beneficiaries continue to struggle and face challenges in the enrollment and comprehension of their coverage. According to the Kaiser Family Foundation (2016), Medicare insurance
Medical Coding Ethics Ethical Concerns in Health Care Delivery: Focus on Medical Coding and Billing Practices The objective of this study is to examine ethical concerns medical coding and billing in the physician office. Medical coding and billing has become very complex in light of health care reform. Recently, Christopher Gregory Wayne, reported to be "dubbed the Rock Doc" was arrested on a dozen charges of Medicare fraud" when he was accused
" (Harman, Flite, and Bond, 2012) the key to the preservation of confidentiality is "making sure that only authorized individuals have access to that information. The process of controlling access -- limiting who can see what -- begins with authorizing users." (Harman, Flite, and Bond, 2012) Employers are held accountable under the HIPAA Privacy and Security Rules for their employee's actions. The federal agency that holds responsibility for the development
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