Medicare, Medicaid, and HIPAA

Denise H- When considering Medicare, Medicaid and HIPAA and the significant impacts on the healthcare industry, two benefits are: to combat waste, fraud, and abuse, and to improve portability and continuity of health insurance coverage. According to the Centers for Medicaid and Medicare Services (CMS), a division of the Department of Health and Human Services, the law “includes provisions to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers” (CMS, 2020). HIPAA also outlines stipulations for the privacy and security of health information. These benefits propelled healthcare organizations to take on accountability and set strict standards on rules and regulations. In return, healthcare in the U.S. has more safeguards for privacy and discrimination.
From a finance and healthcare management standpoint, two challenges when considering Medicare, Medicaid and HIPAA, are healthcare transaction discrepancies and, ironically, fraud and abuse claims. One of HIPAA’s main goals was to combat waste, fraud and abuse within healthcare delivery. Yet, the regulations instituted by HIPAA can be confusing. Nowicki (2018) writes: “One of the most significant initiatives by the federal government to control healthcare costs has been the recent emphasis on enforcing fraud and abuse statutes”. Most of these cases are related to unintentional billing and coding errors, as HIPAA’s rules can be difficult for organizations to navigate. It is imperative that leadership understand the subtleties of the law and educate staff on legal regulations. For example, yearly competency staff training in billing and coding can help prevent unintentional fraud and likewise hefty fines or imprisonment. Please respond to this thread. Refer to order # 8703549272