Title I touches upon the topic of insurance related to unemployed people, especially ones who lost their jobs. Title III addresses the issue of the taxes involving insurance. It also considers the question regarding the pre-tax medical savings accounts and the employees’ related taxes. Title IV is correlated with the insurance regulations for the people with illnesses requiring the additional payments. The situation is relevant for people who have received medical services for more than six months and need continued coverage. Title V regulates insurance policies owned by the company.
Title II reflects the information regarding the various offenses in the healthcare sphere, such as fraud and abuse. From the legal perspective, abuse is considered less dangerous compared to fraud. It includes the lack of knowledge or ignorance aspects. The punishment for the abuse in billing and coding is usually limited by the material compensations for the caused detriment. Fraud is usually prosecuted by the law as an intentional offense breaking the HIPAA regulations (HIPAA Rules and Regulations, n.d.). An example of abuse is when the patient is charged for additional tests which were not vital. The fraud includes more dangerous correlations such as forgery of billing documents (changing dates). The law also protects personal health information of patients (PHI). The regulations touch upon the online storage of personal data. The misuse of insurance information or personal data is a serious offense.
Healthcare Medicare frauds are usually divided into three groups: upcoding, downloading, and unbuilding. The first one is related to coding the more severe diagnoses (Upcoding and Unbundling, n.d.). The second one occurs when the submitted code complies with a lesser payment than it should be. Unbuilding implies the division of provided services to get a higher payment. The discussed regulatory considerations are vital to be aware of for the health insurance specialist. HIPAA is directly related to such specialists’ legal and practical aspects. Therefore, it is vital to learn all the details of coding and billing to avoid dangerous problems and improve the healthcare sphere.
Deskera Content Team. (n.d.). What is an employer identification number (EIN)?. Deskera. Web.
Health Plan Identifier. (n.d.). Howel. Web.
HIPAA Rules and Regulations. (n.d.). CompliancyGroup. Web.
National Provider Identifier Standard. (n.d.). CMS.Goverment. Web.
Upcoding and Unbundling. (n.d.). Phillips & Cohen. Web.