After studying the various coding and billing regulations, I believe the most important and important ones are the Health Insurance Portability and Accountability Act (HIPAA ) and the Affordable Care Act (ACA). HIPAA has established general standards for electronic health care transactions. This also involves the protection and confidentiality of all health information. HIPAA has developed national code sets for submitting and processing insurance claims. These sets of codes provide uniformity across all healthcare providers and services rendered. Each provider is assigned an identification number called the National Provider Identifier (NPI) which allows the provider to be identified by insurance companies and payers when submitting claims. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essay HIPAA compliance is a regulation that holds healthcare organizations responsible for educating and training all healthcare employees in the rules and regulations of this law. This affects reimbursement, as any variation in this law can result in serious consequences, including denial of reimbursement, fines for the organization, and/or closure of a non-compliant organization. Prospective remuneration systems have made it possible to set prices based on diagnosis-related groups (DRG). Once a patient is discharged from the hospital, they are assigned a DRG based on the diagnosis made at the time of discharge. There is a fixed rate that payers will reimburse, which places profits and losses solely on the organization. If their fees are higher than the fixed rate, they will incur losses and may need to evaluate their revenue cycle and reimbursement processes. HIPAA affects potential payment systems because national code sets go hand in hand with diagnosis-related groups. Each service and/or test performed is assigned a code which must match the DRG given at the time of discharge. Any variation could result in a delay in reimbursement and/or refusal of reimbursement. Although HIPAA uses DRGs, they cannot be Medicare DRGs. This statement from CMS explains HIPAA and potential payment systems as they both relate to code sets and DRGs; “DRG codes other than Medicare DRG codes may be used on standard HIPAA electronic transactions with health plans other than Medicare.” Medicare DRGs group similar types of patients treated by a hospital. These cannot be used in standard HIPAA electronic transactions. HIPAA uses DRGs for transactions as well as their code standards which are part of prospective payment systems and fixed rates assigned for services rendered. The Affordable Care Act (ACA) has three primary goals: making health insurance more available and affordable to more people, expanding the Medicaid program, and supporting methods of delivering medical care that aim to reduce the cost general health care (Healthcare.gov). This law focuses on the quality of health care in relation to the quantity of health care received. This law requires patients to be billed based on the value of their health care in relation to their outcomes. Health insurance is now more affordable, and the ACA gives each individual the opportunity to have more control over the health care they receive. This law applies to potential payment systems because it involvesLower reimbursement rates based on services rendered. With health insurance more affordable and easier to obtain, healthcare facilities face lower reimbursement rates for major services such as surgeries and hospitalizations. This places the majority of financial responsibility on patients and could lead to delays in reimbursements and the revenue cycle. Health insurers would have contracts with doctors and involve agreements on reimbursement rates and those rates are lower because of the ACA. Doctors are reportedly afraid that the ACA will force them to expand their services while remaining at the same reimbursement rate. Coding and billing regulations are directly affected by HIPAA and the ACA. “For example, routine supplies, anesthesia, recovery room use, and most medications are considered an integral part of a surgical procedure, so payment for these items is integrated into the APC payment for surgical intervention. This would involve code sets and DRGs. Grouping services rendered involves correct coding and, if done incorrectly, reimbursement could be delayed or denied. The regulations established by the ACA and HIPAA are intended to ensure that patients receive appropriate, good quality care and to ensure that healthcare organizations follow the correct guidelines set forth by any regulations developed. HIPAA provides safeguards for protected health information and also ensures providers follow defined codes for reimbursement. The ACA makes health insurance more affordable and accessible to more people and gives patients more control over the care they receive. Overall, these regulations aim to provide higher quality care at more affordable rates. I believe potential payment systems and HIPAA are what works. This allows for uniformity across the healthcare sector. It's as simple as being assigned a DRG and a set of codes that have fixed rates and submitted claims and allow for faster reimbursement rates. While I agree with the ACA and making health insurance more affordable, they will not pay for or allow reimbursement for certain services. depending on the insurance plan chosen. Yes, insurance is more affordable but the patient can still be held responsible for a service provided that insurance would not fully cover. That's the challenge. Rates are lower, but patient financial responsibility could be increased and could delay and/or deny reimbursement and not end the revenue cycle. Consistent reimbursement delays or refusals could impose a financial burden on an organization. I think some of these regulations should be re-evaluated. Although the ACA offers health insurance at affordable rates, services may or may not be fully reimbursed, which would leave patients with financial responsibility and/or choice between what services they can afford and will receive . It all depends on the type of health insurance plan you have chosen and how much the organization charges for these services and what deductibles the patient will face. I currently do not have health insurance. I tried to get a cheaper insurance plan that covered 6 office visits and a small testing fee. I went to the doctor and although the office visit was covered, only a number of my lab tests were covered, leaving the financial burden on me. Coding and billing must be completed/6/6!/4/2/4@0:0