Task 2: Analyzing Coding and Billing in Reimbursement

Introduction:

Health information management professionals play an important role in the Health Information Management (HIM) team in the area of coding management and reimbursement processes. The Centers for Medicare and Medicaid Services (CMS) introduced quality reporting systems to link financial rewards to the provision of quality healthcare.

In this task, you will describe various components of the coding and billing procedures and how errors may delay reimbursement or result in concerns of fraudulent practice. You will be required to discuss how several specific government directives have impacted healthcare organizations.

Requirements:

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Analyze the quality reporting systems sponsored by Centers for Medicare and Medicaid Services (CMS) by doing the following:

1. Discuss the goals of the Physician Quality Reporting System (PQRS).

a. Describe the advantages and disadvantages of the PQRS.

2. Discuss the goals of the Value-Based Purchasing System (VBPS).

a. Describe the advantages and disadvantages of the VBPS.

3. Describe the role of Health Informatics and Information Management (HIIM) staff in participating in both PQRS and VBPS.

B. Explain the role of Quality Improvement Organizations (QIOs) contracted under CMS as it applies to the reimbursement process.

C. Describe the impact of HIPAA Transaction and Code Set standards on the reimbursement process.

1. Discuss the impact of Code Set Standards on coders.

D. Discuss the impact of the EHR Regulatory Relief Act on healthcare reimbursements.

E. Discuss how emerging technology is evaluated in the reimbursement process.

1. Explain how emerging technology will impact the future of reimbursement.

F. Discuss current or emerging technology that healthcare organizations use to minimize fraud and abuse. Include the following details in your discussion:

• features

• system requirements

• security features

• remote access

• interoperability