Healthcare Reimbursement and Payment Systems, HIM Informatics and Technology Infrastructure HIM560, Southern New Hampshire University

Healthcare Reimbursement and Payment Systems

Journal 4-2 4-2 Journal: Payment Systems HIM-345 Healthcare Reimbursement Shane Standart Southern New Hampshire University Journal 4-2 For the healthcare reimbursement and revenue cycle to work, the payments systems of the organizations of all involved must work correctly and efficiently. There are strict guidelines and regulations that must be met for all legal and ethical considerations to be met that are set by the federal government. HIPPA is the first and most consistently know regulation that all Healthcare organizations, hospitals and insurance companies and third-party payers must always comply with. The implementation of HIPPA within an organization than it is to control and ensure all staff is following the rules and regulations surrounding HIPPA especially when it is applied to portion systems. It is human error whether it be in judgement or inattention that sometimes patient information gets accidentally misused or compromised by healthcare workers and professionals not fully understanding what information is legally deemed to be protected at all costs. One thing noticed at the insurance company I work at, which is actually a third-party payer is the lack of understanding of HIPPA and PHI in general in some individuals. Not everyone fully understands the significance of not compromising someone else's personal health information or the importance of getting an ICD-10 correct as the ultimate effect it has on someone -- payer or payee. The main payment system we deal with is cost reimbursement. Since we are a third-party payer, we are simply given the task and responsibility to correctly and appropriately reimburse the cost the patient or provider has already paid or for services rendered. Also, we pay disability claims and these are more individual (voluntary) policies so we are paying individuals back for the cost they are or have paid for per their policy. Journal 4-2 References Department of Health and Human Services. (n.d.). Compliance Guidance. Retrieved from https://oig.hhs.gov/compliance/compliance-guidance/index.a