MDC Health Information Management Coding And Billing In Reimbursement Research Paper
Miami Dade College
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.
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 Merit-based Incentive Payment System (MIPS).
a. Describe the advantages and disadvantages of the MIPS.
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 MIPS 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:
• system requirements
• security features
• remote access
G. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.