After studying the various coding and billing regulations, I believe the largest and most important ones are HIPAA (Health Insurance Portability and Accountability Act) and Affordable Care Act (ACA). HIPAA established general standards for electronic healthcare transactions. This also involves the protection and confidentiality of all health information. HIPAA has developed a series of national codes for filing and processing insurance claims. These code sets allow for consistency across all healthcare providers and services rendered. Each provider is assigned an identifying number known as a National Provider Identifier (NPI) that allows the provider to be identified by insurance companies and payers when claims are submitted. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay HIPAA compliance is a regulation that holds healthcare organizations responsible for teaching and training all healthcare employees on the rules and regulations of this law. This impacts reimbursement as any variation from this law can result in serious consequences including denial of reimbursement, fines to the organization and/or closure of the non-compliant organization. Future payment systems have allowed rates to be set based on diagnostic groups (DRGs). Once discharged from the hospital, the patient is assigned a DRG based on the diagnosis made at the time of discharge. There is a fixed rate that taxpayers will reimburse and this attributes the profits and losses solely to the organization. If their rate is higher than the fixed rate, they would incur losses and may have to evaluate their revenue cycle and repayment processes. HIPAA impacts future payment systems because national code sets go hand in hand with diagnosis-related groups. Each service and/or test carried out is assigned a code which must correspond to the DRG assigned at the time of disposal. Any variation may result in a delay in reimbursement and/or refusal of reimbursement. While HIPAA uses DRGs, these cannot be Medicare DRGs. This statement from CMS explains HIPAA and future payment systems as they both refer to code sets and DRGs; “DRG codes other than Medicare DRG codes may be used in HIPAA-standard electronic transactions with health plans other than Medicare.” Medicare DRGs group together similar types of patients treated by a hospital. These cannot be used as part of HIPAA standard electronic transactions. HIPAA uses DRGs for transactions along with their code standards which are all part of future payment systems and fixed fees assigned for services rendered. The Affordable Care Act (ACA) has three main goals: to make health insurance more available and accessible to more people, to expand the Medicaid program, and to support methods of providing medical care that aim to reduce the cost of health care overall (Healthcare.gov). This act focuses on the quality of health care versus the quantity of health care someone receives. This act wants patients to be billed based on the value of their healthcare in relation to their outcome. Health insurance is now more affordable, and the ACA gives each individual the ability to have more control over the health care they receive. This law applies to future payment systems because it results in lower reimbursement rates based on services rendered. With health insurance plusAffordable and easier to obtain, healthcare facilities are facing lower reimbursement rates for major services such as surgeries and hospital stays. This places the majority of the financial responsibility on patients and could cause delays in reimbursement and the revenue cycle. Health insurers would have contracts with doctors and agreements involved on reimbursement rates and these rates are lower because of the ACA. Doctors reportedly feared that the ACA would require them to expand their services while remaining at the same reimbursement rate. Coding and billing regulations are directly impacted by HIPAA and the ACA. “For example, routine supplies, anesthesia, recovery room use, and most medications are considered an integral part of a surgical procedure, so payment for these items is integrated into the APC payment for the surgical procedure” . This would involve code sets and DRGs. The packaging of the services rendered requires correct coding and, if done incorrectly, the refund may be delayed or denied. The regulations established by the ACA and HIPAA aim to ensure that patients receive appropriate, good quality care and to ensure that healthcare organizations follow the correct guidelines established by all regulations developed. HIPAA provides safeguards for protected health information and also ensures that providers follow set codes for reimbursement. The ACA makes health insurance more affordable and available to more people and allows patients to have more control over the care they receive. Overall, these regulations aim to provide higher quality care at more affordable rates. I believe future payment systems and HIPAA are what works. It allows for consistency across the healthcare industry. It's as simple as receiving a DRG and a set of codes that provides fixed rates and claims submitted and allows for faster reimbursement rates. Even though they agree with the ACA and make health insurance more affordable, they will not pay or allow reimbursement for certain services based on the insurance plan you choose. Yes, insurance is more affordable, but the patient can still be held liable for a service rendered that insurance would not fully cover. This is the challenge. Rates are lower but the patient's financial responsibility may be increased and may delay and/or deny reimbursement and not end the revenue cycle. Consistent delays or refusals to refund could place a financial burden on an organization. I think some of these regulations need to be re-evaluated. While the ACA provides health insurance at affordable rates, services may or may not be fully reimbursed, which would leave patients with the financial responsibility and/or choice between which service they can afford and which they will receive. It all depends on the type of health insurance plan you have chosen and the cost that the organization charges for such services and deductibles that the patient will face. I currently do not have health insurance. I attempted to get a cheaper insurance plan that covered 6 office visits and minimal testing costs. I went to the doctor, and although the office visit was covered, only a certain amount of my lab tests were covered, leaving me with the financial burden. Coding and billing must be done correctly to include compliance with established regulations. Documentation is very important and any missing codes or information may result in delays and denial of refund. I currently work in the home healthcare industry, but prior to this job I worked within a practice/6/6!/4/2/4@0:0