Healthcare Claims and Processing

1600 Words7 Pages
A current LCD for the regional Medicare intermediary (Michigan - Region V) is shown in the example below. This LCD is for Erythropoiesis Stimulating Agents, L25211. The LCD is active and became effective on 12/1/2007 with an date of 11/01/2013 for the 10/22/2013 revision (, 2014b).

Question 8: Report on the Health Insurance Portability And Accountability Act (HIPAA) and its impact on healthcare claims processing. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was created, in part, to make health insurance portable in an attempt to address the problem of the growing amount of people that are uninsured and underinsured (NASW,2002). The Act allows a person with preexisting medical issues to get health
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Use of Version 5010 became effective January 1, 2012 and replaced version 4010A1 (, 2014c).
Question 9: Compare using a chart the classifications, taxonomies, nomenclatures, terminologies and clinical vocabularies used in healthcare claims processing.

Question 10: Explain the role of The Office Of Inspector General (OIG) in coding compliance, auditing and reporting. Select one audit from the current OIG Work Plan and describe the focus and intent of the audit.
In Michigan, the Office of the Inspector General (OIG) was created in 1972 by the Michigan Department of Health and Human Services to help maintain accountability in efficient and appropriate administration of HHS programs (OIG, 2013). The OIG investigates alleged fraud in these programs as well as reviewing policies and procedures and recommending improvements in ways to counteract and detect fraud. In addition, OIG monitors compliance with reimbursement regulations. OIG provides guidance documents for compliance programs for various types of providers to use to develop compliance programs in their facilities. The compliance plans include development of policies, including those for accurate coding, internal monitoring and auditing, naming of a compliance officer, and appropriate training (Peden, 2012).
One of the Public Health Agencies that HHS audits is the Centers for Disease Control and
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