Analysis of Compliance, Coding, and Reimbursement in Healthcare

This report examines healthcare compliance, coding, and reimbursement, focusing on key regulations and their impact on the healthcare industry. The report begins by highlighting the Health Insurance Portability and Accountability Act (HIPAA) and its significance in maintaining patient confidentiality. It then explores Senate Bill 1264, which addresses out-of-network billing practices and provides a framework for resolving healthcare plan issues. Additionally, the report discusses Virtual Credit Card (VCC) legislation and its implications for provider reimbursement. The report references relevant literature to support its analysis and provide context to the current healthcare landscape. Overall, the report provides a comprehensive overview of the legal and regulatory environment influencing healthcare practices and financial transactions.

Running head: COMPLIANCE, CODING, AND REIMINSTRUCTIONS
COMPLIANCE, CODING, AND REIMINSTRUCTIONS
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Compliance, Coding, and Reiminstructions
The National government of the U.S. have enacted various laws and regulations in the
medical industry. The most prevailing law is the Health Insurance Portability and
Accountability Act (HIPAA). It had created several changes in the industry in the last few
decades, which consist of medical billing laws and regulations. One of the most important
ones is patient confidentially that mandates the medical practice need to be created in such a
manner that it safeguard any information that has the potential of leaking. For example, each
medical officer needs to sign a form that involves understanding and commitment related to
patient confidentially (Edemekong & Haydel, 2019). The second regulation involves Senate
Bill 1264 that had recently been passed in the 86th Texas legislation that limits the out-of-
network providers in practising balancing billing and formulates a process that smoothly
resolves the issue related to healthcare plan of the providers. Whedon et al. (2017) opined
balance billing as a situation when a healthcare provider bills a patient in term of difference
between reimbursement given by the health insurance and amount charged by the provider.
The third regulation is Virtual credit card (VCC) legislation that was enacted in 2016 that
require a health insurer to include language in the billing contract and restrict the payer-to-
provider reimbursement via VCC. An example is the provider had to allow ACH payment
that was honoured in creating an opt-out provision (Greens, 2018). The providers, in this
case, includes dentists, licensed physicians, optometrists and other healthcare professionals
and facilities that have obtained a license from the government.

References
Edemekong, P. F., & Haydel, M. J. (2019). Health Insurance Portability and Accountability
Act (HIPAA). In StatPearls [Internet]. StatPearls Publishing.
Green, M. (2018). Understanding health insurance: A guide to billing and reimbursement.
Cengage Learning.
Whedon, J., Tosteson, T. D., Kizhakkeveettil, A., & Kimura, M. N. (2017). Insurance
reimbursement for complementary healthcare services. The Journal of Alternative and
Complementary Medicine, 23(4), 264-267.