Essay on "Reimbursement Ethics and Compliance: Impact"

Essay 4 pages (1349 words) Sources: 3

[EXCERPT] . . . .

The research shows there will be increased reimbursements from Medicaid (PRN News, 2013). Essentially, the reform "expands Medicaid to include 133% of federal poverty level which is $29,327 for a family of four" (Jackson & Nolen, 2010). Also, the bill is expanding Medicaid coverage to "childless adults" in 2014 (Jackson & Nolen, 2010). This will increase the number of individuals using Medicare and Medicaid as a way to help pay for their health care costs. According to the research, "physicians that normally might be reluctant to see Medicaid patients due to meager reimbursements will be more willing if they know that the payoff will be better. The billing and coding industries that serve them will benefit as well from increased physician revenue" (PRN News, 2013). This means that more attention must be paid to the coding involving Medicare and Medicaid cases.

Possible influences of mandatory compliance programs on the coding practice -- how will it be different than the current state of coding? In order to meet this growing demand for healthcare needs, more medical professionals will be needed, including those working in medical coding and billing. Essentially, "the need for billing and coding professionals is going to increase because of the increased number of people who will be submitting claims to insurance as well is expanded Medicare and Medicaid coverage" (Eastaugh & Sternal-Johnson, 2010). More medical billing staff will be needed by individual healthcare facilities in order to appropriately handle the increasing workload that the reforms would entail. This means new hires and a larger workforce within the medical billing industry. According to the research, "obviously there will be extensive training required for all current billing professionals to learn all the new rules" (Eastaugh & Sternal-Johnson, 2010). This would require more training, both for new hires and those medical billing professionals that will need to be retrained on new procedures under the reform statutes. The new heath care reforms will also help provide more funding for all types of training and educational programs for already established and beginning medical professionals (PRN News, 2013). This means that the need for more training to meet new practices in medical billing will be met with greater level of funding, and thus will provide a strong level of efficiency in helping medical billing professionals understand the nature of the new changes.

However, the bigger reimbursements coming in from Medicaid could lead to potential fraud or abuse. Individuals may exaggerate reimbursements in order to ensure that the physicians they work for get increasing funds from Medicare and Medicaid. This might be on behalf fraudulent physicians, who are demanding that their medical billing professionals working under them exaggerate claims costs as a way to increase their overall profit potential (Hart, 2012). There are other potential situations for fraud and abuse under the changing system as well. With more and more billing directed towards federal programs, like Medicare and Medicaid, some billing professionals might over bill. Additionally, some physicians might recommend unnecessary procedures as a way to increase the amount billed to federal programs. To combat these potentials for fraud, the new Health Care Reform Law has also set aside greater funding for preventing and tracking down those who would abuse the system. Here the research suggests that "while new regulations possibly mean more bureaucracy and paperwork, most industry professionals think it will be a positive change" to help expose those who would be abusing the system at patients expense (PRN News, 2013). It is important that these new reform procedures are monitored, especially within the first few years of implementation.

References

Eastaugh, Ben & Sternal-Johnson, Chris (2010). What will health care reform do to medical billing? MD Alliance Billing. Web. http://mdalliancebilling.wordpress.com/2010/03/22/what-will-health-care-reform-do-to-medical-billing/

Griffey, Kimberly. (2013). Medical billing and coding and health care reform: What you need to know. Ultimate Medical Academy. Web. http://info.ultimatemedical.edu/blog/bid/276367/Medical-Billing-and-Coding-and-Health-Care-Reform-What-you-Need-to-Know

Hart, Bradley. (2012). Ethics in Medical Coding: Theory and Practice. McGraw Hill.

Jackson, Jill & Nolen, John. (2010). Health Care Reform Bill summary: A look at what's in the bill. CBS News. Web. http://www.cbsnews.com/8301-503544_162-20000846-503544/health-care-reform-bill-summary-a-look-at-whats-in-the-bill/

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