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.
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Get Help Now! 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
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