Optum360 coding books logo
Optum360Coding.com
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
January 25, 2018


Four Tests Added to List of CLIA Waived Tests

In early January, the Centers for Medicare and Medicaid Services (CMS) announced new waived tests... Learn More


New and Revised Vaccine Codes Added to 2018 CPT Code Book

The American Medical Association (AMA) added and revised several vaccine CPT codes for its 201... Learn More


OIG Recommends Measures for Curbing Opioid Misuse and Fraud

Office of Inspector General testimony before the House Committee on Ways and Means in January ... Learn More


View Article Archive

Subscribe:
To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:
 

Medical Coding News Archives

Obamacare: Call It What It Is—Patient Protection and Affordable Care Act

 
November 29, 2012:

Brigid T. Caffrey, BA, BS, CCS, Manager, Clinical/Technical Editors

Maybe referring to the Patient Protection and Affordable Care Act by its formal name will help dispel some of the misinformation about the health care bill. A study by the bipartisan Congressional Budget Office concluded that this act, which will be in full effect by 2014, will lower the budget deficit by $143 billion over 10 years due to planned taxes and cost offsets.

With little more than a year to go to full implementation, let’s review some of the main aspects of ensuring that all Americans have insurance choices and access to health care services.

Patient protection:

  • Eliminates discriminatory practices:
    • Individuals cannot be denied due to pre-existing conditions
    • Individuals cannot be dropped due to illness
    • Individuals cannot be charged higher premiums because of health issues
    • Payers cannot limit/cap lifetime or annual benefits
    • Individuals cannot be made to pay higher premiums due to age, sex, geographical area
    • Individuals cannot be denied coverage due to eligibility rules based on financial status
  • Insures more Americans:
    • Allows children up to age 26 to be covered on their parents’ plans
    • Makes insurance available to those currently uninsured, either through incentives to employers, Medicaid, or tax credits and insurance exchanges
  • Guarantees coverage:
    • Provides for preventive and screening services without cost-sharing, such as blood pressure screening, colorectal cancer screening, immunizations, mammography, contraception, well-woman visits
  • Establishes an external appeals process:
    • Creates ombudsman programs to advocate for the beneficiary in cases of complaint, appeal, and administrative issues

Affordable care:

  • Reduces costs by making services available to those who now use visits to the emergency room as their primary health plan
  • Closes the coverage gap (donut hole) for the Medicare drug plan
  • Removes barriers to urgent care, such as referrals or physician approval, and saves the beneficiary from assuming the costs
  • Allows shopping for and purchasing of insurance through marketplace pools via health exchanges, thus using the combined buying power for individuals to afford private health insurance that may not exceed a percentage of an individual’s income
  • Provides tax credits to small businesses to cover up to 50 percent of their total employee premium payments
  • Requires insurance companies to spend at least 80 percent of the premium payments on medical services and not on advertising and executive salaries; those who fail to prove compliance must send rebates to policyholders

Costs of the act are offset by:

  • Requiring those who refuse health care insurance to pay a penalty in the form of a tax to contribute to the health care coverage for the rest of Americans
  • Lowering payments to hospitals
  • Increasing Medicare taxes on high-income households
  • Assessing penalties on large business employers who do not offer health care insurance
  • Assessing taxes on various health-related activities, such as assessing indoor tanning services at a 10 percent excise tax and elective cosmetic surgery at a 5 percent excise tax
  • Reducing overhead by consolidating the higher education loan program with the Pell Grant Program

 

 
Sign in to
Your Account
USERNAME
Forgot your username?
PASSWORD
Forgot your password?
Don't have an account?
It's easy to create one.
Promo code

Have a promotional source code? Enter it here:


What is this?