Healthcare Laws

There are many changes occurring within healthcare in the United States. The major reasons why the healthcare system is undergoing dramatic revision and reform have to do with the number of uninsured, and/or underinsured, individuals and the cost of healthcare. This healthcare reform is centered around broad categories of change:

·  Increasing the population of individuals receiving health care insurance coverage.

·  Increasing the number of health care providers available to the public.

·  Improving access to specialists providing health care.

·  Improving the quality of health care.

·  Decreasing the cost of health care goods and services.

·  Patient privacy

Because these reforms will impact you daily as a coder or billing specialist, having a thorough understanding of them is important. Title II will be the most impactful on you as a professional in healthcare and should include the most detail of the five components.

By using the Figure 5-5, on page 129 of your text, review the five titles/components of HIPAA.

Determine the significance of the regulatory considerations for the Health Insurance Specialist.

Include the following aspects in the assignment:

Ø  Provide a brief summary describing the purpose of Titles I, III, IV and V.

Ø  Discuss topics on Title II by expanding on:

o  PHI

o  The difference between fraud and abuse

o  Upcoding, downcoding and unbundling

o  The meaning of the identifiers EIN, NPI, and HPID

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