Healthcare has various laws touching on areas such as documentation, reporting, coding, and billing. Documentation of healthcare data helps in payment and other related health uses. Coding entails classifying clinical information into system terminology, which reflects on the patient condition and care evolution (Neville, 2015). Reforms such as the Two-Midnight rule, My Healthcare Cost Estimator, and modification of reimbursement rates together with patients’ allowances are some of the regulations that continues to affect healthcare organizations.
The Two-Midnight rule directs that payment of inpatient admission be appropriate under Part A of Medicare. The law states that an inpatient stay is expected to at least last two midnights. The Centers for Medicare and Medicaid (CMS) and the Quality Improvement organizations (QIOS) will be responsible for auditing patient status, while the focus of the Audit Recovery program is directed towards healthcare facilities with high rates of denial. They determine if there has been medically made arrangements for inpatient admission. Inpatient claim is denied if the entry was not reasonable and care would have been provided in outpatient basis (Neville, 2015). The rule helps the hospital to document their coding and billing properly for them not to lose on reimbursement.
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The development of my healthcare Cost Estimator application helps people search for medical care cost provided by different health providers. The previous norm of the pricing was dictated by billing professional. Since then, has shifted from doctors to patients who are now in the position to know the cost of treatment. The technology will impact on the revenue received by different healthcare organizations based on whether their prices are high or not.
The modification of reimbursement rates and patients allowances have made insurance plans to change their coverage due to the Affordable Care Act. The government strives to offer insurance to all its citizens with a focus being on reducing the cost. For example, a patient having a restructured employer plan may not be insured for more therapy sessions per program in cases involving coding and billing involving physical therapist. Consequently, the reimbursement rate for the meetings would have been decreased. Therefore, all these new developments will continue to influence the payments in healthcare organizations.
References
Neville, D. B. (2015). How regulations affect coding and documentation. ELSEVIER . Retrieved on 3 November 2017, from http://icd-10online.com/wp-content/uploads/2015/10/Interdependencies-of-Regulations-white-paper.pdf.
