HCS468 V1 Health Care Policies
HCS468 V1health Care Policies
Research and select 1 health care law and 1 health care policy, then summarize each, explain one element of each, and describe how each is regulated. Support research with APA citations.
Paper For Above instruction
The selected health care law is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA was enacted to protect individuals' medical records and personal health information while ensuring the privacy and security of such data, promoting health information exchange and confidentiality (HHS, 2020). An essential element of HIPAA is the Privacy Rule, which establishes national standards for the protection of health information, giving patients rights over their health data and setting limits on its use without consent (Zubich, 2022). HIPAA is regulated by the Department of Health and Human Services (HHS), specifically through the Office of Civil Rights (OCR), which enforces compliance, investigates violations, and imposes penalties for non-compliance. Penalties for HIPAA violations can range from civil fines of up to $1.5 million per violation, depending on the severity and neglect involved (HHS, 2020).
The selected health care policy is Medicare (CMS) Policies. Medicare is a federal program that provides health insurance to individuals aged 65 and older, along with certain younger individuals with disabilities or specific conditions, aiming to improve access to healthcare and reduce financial strain (CMS, 2022). An essential element of Medicare policy involves coverage and billing regulations, which specify eligible services, documentation requirements, and reimbursement procedures to ensure proper patient care and compliance. Regular review of Medicare policies is mandated to adapt to changing healthcare needs and technological advancements (Zubich, 2022). The regulation of Medicare policies is overseen by the Centers for Medicare & Medicaid Services (CMS), which enforces compliance through auditing, monitoring billing practices, and penalizing fraudulent or non-compliant providers. Penalties for non-compliance include fines, Medicare billing revalidation, and exclusion from Medicare programs (CMS, 2022).
References
- Centers for Medicare & Medicaid Services (CMS). (2022). Medicare overview. https://www.cms.gov/Medicare/Medicare
- U.S. Department of Health and Human Services (HHS). (2020). Summary of the HIPAA Privacy Rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
- U.S. Department of Health and Human Services (HHS). (2020). HIPAA enforcement and penalties. https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/maintaining-compliance/index.html
- Zubich, T. (2022). Week 2 assignment—Extra help and example for completion of the health care policy worksheet. Unpublished manuscript.