How Billing and Coding Regulations Affect Reimbursement in Healthcare
Instructions
How do billing and coding regulations affect reimbursement in a healthcare organization? What are the various tasks the different healthcare departments do relating to the reimbursement process?
HCM 345 Journal Guidelines and Rubric
Journals are private between the student and the instructor. These journals are meant to offer you an opportunity to reflect on real-world experiences related to healthcare administration as well as the opportunity to put your critical thinking skills to work by expressing your thoughts in response to the questions assigned for you to answer.
Specifically, the following critical elements must be addressed:
- Application of healthcare reimbursement concepts that are relevant to the journal prompt
- Personal reflection about course content from real-world examples you have witnessed, read about, experienced, or expect to experience
Approach these activities as (a) an opportunity to reflect upon and apply what you learn each week based on the assigned readings, discussions, and activities, and (b) an opportunity to share your knowledge and expertise based on your educational and professional experiences in the past. As a successful professional, you will need good reflective and writing skills. Journal activities offer you the opportunity to further develop these skills.
Guidelines for Submission: Submit assignment as a Word document with double spacing, 12-point Times New Roman font, and one-inch margins.
Critical Elements |
Exemplary (100%) |
Proficient (85%) |
Needs Improvement (70%) |
Not Evident (0%) |
Value |
Reimbursement Concepts |
Meets “Proficient” criteria and uses course resources to support ideas |
Discusses health reimbursement issues and includes an accurate and detailed explanation of the key aspects of the topic |
Discusses health reimbursement issues but lacks details pertaining to the key aspects of the topic |
Does not discuss health reimbursement issues |
40 |
Reflection |
Meets “Proficient” criteria and uses concrete examples to make connections |
Includes a personal reflection that makes connections to current or future profession |
Includes a reflection, but it lacks details or connections to current/future profession |
Does not include a reflection |
40 |
Articulation of Response |
Journal assignment is free of errors in organization and grammar |
Journal assignment is mostly free of errors of organization and grammar, which are marginal and rarely interrupt the flow |
Journal assignment contains errors of organization and grammar, but they are limited enough so that the assignment can be understood |
Journal assignment contains errors of organization and grammar, making the assignment difficult to understand |
20 |
|
|
|
|
Earned Total |
100% |
Healthcare
Author’s Name
The Institutional Affiliation
Course Number and Name
Instructor Name
Assignment Due Date
Healthcare
Introduction
Billing and coding regulations are the important compliance guidelines for the healthcare institutions to acquire claims, mainly from health insurance companies, in exchange for delivered services. The regulations state that the healthcare institutions should issue medical coding reports to the third-party providers, comprising of diagnosis, treatment and applied charges for the services (Carlo et al., 2019). The healthcare institutions experience influences on the reimbursements due to the billing and coding regulations collectively.
Discussion
The billing and coding regulations are deployed by the Health Insurance Portability, and Accountability Act (HIPPA) has introduced three coding, namely ICD, CPT and HCPCS. The objective of developing such billing codes is to introduce administrative simplification for healthcare institutions. Once the healthcare practitioners interact and diagnose a problem in a patient, the diagnosis and procedure codes are allotted by the medical biller. The bil...
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