Answer in complete sentences, and be sure to use correct English spelling and gr
ID: 3507603 • Letter: A
Question
Answer in complete sentences, and be sure to use correct English spelling and grammar. Sources must be cited in APA format. Your response should be two (2) to four (4) pages in length; refer to the "Assignment Format" page for specific format requirements.
Lesson 1, 2, 3, and 4 of this course has covered a wide variety of topics. Thus far, you have learned a great deal of information on health insurance, medical contracts, HIPAA, physician and hospital medical billing, and Medicare and Medicaid.
For this writing assignment, please explain why the following course objectives are important for medical billers and coder to understand:
1.Understand the history and impact of health insurance on health care reimbursement process and recognize various types of health insurance coverage.
2.Identify the key elements of a managed care contract and identify the role HIPAA plays in the health care industry.
3.Recognize and explain the different components of physician and hospital billing and differentiate between the two types of services.
4.Explain the difference between Medicare and Medicaid billing.
Please include at least 3 scholarly articles within your response. Overall response will be formatted according to APA style and the total assignment should be between 2-4 pages not including title page and reference page.
Explanation / Answer
The medical billing is mainly a payment practice within the developed countries like United States health system. The process involves a healthcare provider submitting, and following up on, claims with health insurance company in order to receive payment for services rendered, such as treatments and investigations. The same process is used for most insurance companies, whether they are private companies or government sponsored programs, Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly. Medical billers are encouraged, but not required by law.
The course objectives are important for medical billers and coder to understand history and impact of health insurance on health care reimbursement process Health insurers currently utilize health care technology assessments, in both coverage determination and reimbursement decisions. Nevertheless, these assessments are often limited in scope and value. New comparative effectiveness research has the potential to be incorporated into the already existing mechanisms for coverage and treat- ment decisions, as well as help further define and improve the value and quality of health care.
are put in place to incorporate new treat- ment and technology assessment ndings into coverage and reimbursement decisions can include the ndings resulting from new comparative effectiveness research. However, health information systems need to be able to distinguish between speci c treatments. Otherwise, health insurers will not be able to set different coverage and reimbursement policies for the different treatment options. This may require that International Classification of Diseases (ICD), Current Proce- dural Terminology (CPT), and Healthcare Common Procedure (HCPC) codes be nely differentiated to account for these variations. As the de nition of quality of health care is further re ned by comparative effectiveness studies, it will likely lead to higher expectation for measuring and evaluating variation around provider performance and member compliance. That data will also be essential for the implementation of potentialt incentive strategies as well as reimbursement policies.
Now to understand the key elements of managed care anad identify the role of HIPAA in health care industry-
HIPAA is health insurance portability and accountability
There are several rules for hipaa for proffesionals so they need to understand also understand its importance maintain secrecy of informations and then workout on them to make people understand there rights and complains.
The difference between the medicare and medical billing-
In US, Medicare is a single-payer, national social insurance program administered by the U.S. federal governmentsince 1966, using private insurance companies across the United States under contract. United States Medicare is funded by a payroll tax, premiums and surtaxes from beneficiaries, and general revenue. It provides health insurance for Americans aged 65 and older who have worked and paid into the system through the payroll tax. It also provides health insurance to younger people with some disability status.
On other hand medical billing healthcare provider submitting, and following up on, claims with health insurancecompanies in order to receive payment for services rendered; such as treatments and investigations. The same process is used for most insurance companies, whether they are private companies or government sponsored programs -Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly. Medical billers are encouraged.
Thus its important to understand course objectives for medical billers and coder.