Health Medical Homework Help

DISCUSSION #1

In this Discussion, review the following concepts pertaining to clinical coding-reimbursement connection: Communication of the services provided is transmitted from the provider to the third-party payer, public or private, via coded information.

1. The code sets to be used for healthcare services reporting by both public and private insurers were designated by what legislation?
2. How is this other legislation ensuring security of healthcare information (fraud or abuse)

DISCUSSION #2

In this Discussion, review the following concepts pertaining to voluntary health insurance (VHI): VHI is the umbrella term that includes private or commercial healthcare insurance plans and Blue Cross and Blue Shield plans.

1. Describe the types of procedures and services that typically require prior approval.

2. Describe the rationale for requiring prior approval.