Journal 2-2
2-2 Journal: Compliance, Coding & Reimbursement
HIM-345 Healthcare Reimbursement
Shane Standart
Southern New Hampshire University
Journal 2-2
For the healthcare reimbursement and revenue cycle to work, correctly and efficiently and even
legally, there must first be billing and coding regulations that are followed and adhered to.
When all of this done properly then each reimbursement and ultimately the whole revenue
cycle can be affected in the most positive way possible.
HIPPA is the first and foremost regulation that all Healthcare organizations, hospitals and
insurance companies must always comply with and never ever compromise. HIPPA, or the
Health Insurance Portability and Accountability Act, emphasizes the vital importance of patient
confidentiality. 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. When this is not understood or complied with it can have
negative effects throughout reimbursement and revenue. One way to safeguard a patient's info
is all facilities and organizations be current on ICD-10 codes which give the most accurate
description of their illness or condition. Additionally, if this information isn't correct or a
patient's information isn't correct, compromised or not, then that information going to an
insurance company is already in trouble and will not be reimbursed correctly or appropriately
Another mandatory regulation, set up by the Healthcare Reform Act, is that healthcare facilities
and organizations must strictly comply with is electronic medical records, especially any and
all financial transactions. This helps to ensure all healthcare providers and facilities are using
electronic health record systems so all billing is done electronically with inherent HIPPA rules
to be followed. This is definitely a safeguard put in place to limit the number of mistakes which
Journal 2-2
made inadvertently causes financial distress or burdens for a facility or organization or even
down the line a patient.
The third regulation to be followed, and which is mandated also, is the Office of Inspector
General Compliance. This is a regulation which works hand in hand with HIPPA by ensuring
each procedure which is offered and covered is done so within HIPPA's inherent privacy and
security laws. The sole purpose of this to is greatly limit or prevent fraudulent claims or activity
from happening so that the unnecessary financial distress and burdens can be avoided. The
Office of Inspector General helps to "unpack" and "unbundle" global codes or bundled codes as
well as simple single claims. The regulations set by the OIG are crucial in all of this as the
foremost purpose is to protect the patients privacy and rights as well obtaining the most
accurate information the healthcare organizations and facilities provide so everything billed is
done so legally and appropriately.
Additionally, what is becoming more and more common for the way to be paid is the revenue
cycle friendly organizations known as third-party payers. The third-party payer's main function
is to negotiate pricing and contractual allowances as well as payment terms and timing
(Rauscher, Wheel