MVCC Impact of Hipaa Transaction and Code Set Standards DiscussionSchool

Moraine Valley Community College

Question Description

A. Analyze the quality reporting systems sponsored by Centers for Medicare and Medicaid Services (CMS) by doing the following:

1. Discuss the goals of the Merit-based Incentive Payment System (MIPS).

a. Describe the advantages and disadvantages of the MIPS.

2. Discuss the goals of the Value-Based Purchasing System (VBPS).

a. Describe the advantages and disadvantages of the VBPS.

3. Describe the role of Health Informatics and Information Management (HIIM) staff in participating in both MIPS and VBPS.

B. Explain the role of Quality Improvement Organizations (QIOs) contracted under CMS as it applies to the reimbursement process.

C. Describe the impact of HIPAA Transaction and Code Set standards on the reimbursement process.

1. Discuss the impact of Code Set Standards on coders.

D. Discuss the impact of the EHR Regulatory Relief Act on healthcare reimbursements.

E. Discuss how emerging technology is evaluated in the reimbursement process.

1. Explain how emerging technology will impact the future of reimbursement.

F. Discuss current or emerging technology that healthcare organizations use to minimize fraud and abuse. Include the following details in your discussion:

• features

• system requirements

• security features

• remote access

• interoperability

G. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

RUBRIC

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A1. MIPS: GOALS:

NOT EVIDENTA discussion is not provided.

APPROACHING COMPETENCEThe discussion of the MIPS contains some inaccuracies about the system’s goals.

COMPETENTThe discussion accurately addresses the goals of the MIPS.

A1A. MIPS: ADVANTAGES AND DISADVANTAGES:

NOT EVIDENTA description is not provided.

APPROACHING COMPETENCEThe description does not accurately describe the advantages and disadvantages of the MIPS.

COMPETENTThe description accurately describes both the advantages and disadvantages of the MIPS.

A2. VBPS: GOALS:

NOT EVIDENTA discussion is not provided.

APPROACHING COMPETENCEThe discussion does not accurately describe the goals of the VBPS.

COMPETENTThe discussion accurately addresses the goals of the VBPS.

A2A. VBPS: ADVANTAGES AND DISADVANTAGES:

NOT EVIDENTA description is not provided.

APPROACHING COMPETENCEThe description does not accurately describe the advantages and disadvantages of the VBPS.

COMPETENTThe description accurately describes the advantages and disadvantages of the VBPS program.

A3. HIIM STAFF ROLE:

NOT EVIDENTA description is not provided.

APPROACHING COMPETENCEThe description is illogical or does not describe the role of HIIM professionals in MIPS and VBPS

COMPETENTThe description is logical and describes the role of HIIM professionals in participating in both MIPS and VBPS.

B. QUALITY IMPROVEMENT ORGANIZATIONS:

NOT EVIDENTAn explanation is not provided.

APPROACHING COMPETENCEThe explanation is illogical, does not explain the role of QIO’s contracted under CMS, or does not explain the relevance to the reimbursement process.

COMPETENTThe explanation is logical and explains the role of QIOs contracted under CMS and explains the relevance to the reimbursement process.

C. HIPAA TRANSACTION AND CODE SET STANDARDS:

NOT EVIDENTA description is not provided.

APPROACHING COMPETENCEThe description is illogical or inaccurately describes the impact of the HIPAA Transaction and Code Set standards on the reimbursement process.

COMPETENTThe description is logical and accurately describes the impact of the HIPAA Transaction and Code Set standards on the reimbursement process.

C1. IMPACT ON CODERS:

NOT EVIDENTA discussion is not provided.

APPROACHING COMPETENCEThe discussion does not accurately discuss the impact of the Code Set Standards on coders,.

COMPETENTThe discussion accurately details the impact of the Code Set Standards on coders.

D. IMPACT OF EHR:

NOT EVIDENTA discussion is not provided.

APPROACHING COMPETENCEThe discussion does not accurately discuss the impact of the EHR Regulatory Relief Act on healthcare reimbursements.

COMPETENTThe discussion accurately discusses the impact of the EHR Regulatory Relief Act on healthcare reimbursements.

E. EMERGING TECHNOLOGY IN REIMBURSEMENT:

NOT EVIDENTA discussion is not provided.

APPROACHING COMPETENCEThe discussion is illogical regarding how emerging technology is evaluated in the reimbursement process.

COMPETENTThe discussion is logical and discusses how emerging technology is evaluated in the reimbursement process.

E1. FUTURE OF REIMBURSEMENT:

NOT EVIDENTAn explanation is not provided.

APPROACHING COMPETENCEThe explanation does not logically explain how emerging technology will impact the future of reimbursement or the explanation is poorly supported.

COMPETENTThe explanation logically explains how emerging technology will impact the future of reimbursement and the explanation is well supported.

F. IDENTITY FRAUD AND ABUSE:

NOT EVIDENTA discussion is not provided.

APPROACHING COMPETENCEThe discussion does not logically discuss a current or emerging technology that healthcare organizations use to minimize fraud and abuse or the discussion does not include each of the given points and how they are relevant to minimizing fraud.

COMPETENTThe discussion logically discusses a current or emerging technology that healthcare organizations use to minimize fraud and abuse. The discussion includes each the given points and how they are relevant to minimizing fraud.

G. APA SOURCES:

NOT EVIDENTThe submission does not include in-text citations and references according to APA style for content that is quoted, paraphrased, or summarized.

APPROACHING COMPETENCEThe submission includes in-text citations and references for content that is quoted, paraphrased, or summarized but does not demonstrate a consistent application of APA style.

COMPETENTThe submission includes in-text citations and references for content that is quoted, paraphrased, or summarized and demonstrates a consistent application of APA style.

PROFESSIONAL COMMUNICATION:

NOT EVIDENTContent is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic.

APPROACHING COMPETENCEContent is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective.

COMPETENTContent reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding.