Compare and contrast the various billing and coding regulations.

Compare and contrast the various billing and coding regulations researched in Module Two to determine which ones apply to prospective payment systems.

Compare and contrast the various billing and coding regulations

4-2 Journal: Payment Systems
Compare and contrast the various billing and coding regulations researched in Module Two to determine which ones apply to prospective payment systems. Reflect on how these regulations affect reimbursement in a healthcare organization. Assess the impact of regulations on reimbursement in a healthcare organization and explain what you think is working and what could be a challenge. If possible, bring in a real-world example either from your life or from something you have read about.

More details;

Prospective Payment for Healthcare Services

In 1983-1984 the Centers for Medicare and Medicaid Services (CMS) set forth a system of payment for the operating costs for healthcare organizations based on prospectively set rates. Under the Prospective Payment System (PPS), cases are also categorized into diagnosis-related groups (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat patients in that DRG.

Healthcare organizations bill CMS for the services it delivers by reporting established codes, known as ICD-10-CM.(International Classification of Diseases, Tenth Revision, and Clinical Modification). ICD-10 is also a system used by healthcare providers to classify and code all diagnoses. Also, symptoms and procedures recorded in conjunction with the services delivered to a patient.

Since providers receive a pre-established payment rate based on the assigned DRG for each case. It is to the financial advantage of the provider to deliver quality outcomes with the most effective and efficient use of resources. Providers delivering care for a cost less than the DRG payment rate benefit financially. The challenge arises for providers who deliver care to an elderly population. Or patients who suffer from chronic conditions, such as diabetes, COPD, cancer, and chronic pain. In these cases, the cost of care can be significantly greater than the DRG payment. This contributes to significant financial loss.

superadmin (28431)
New York University

Hire an Expert to Help you

Hire Verified Expert

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
Have a homework question? Get help from verified tutors now!

Are You Looking For Assignment Help? We Can Certainly Assist You