Name and describe the law and give the code

Assignment Help Other Subject

Reference no: EM133432762

The Affordable Care Act (ACA) included an "employer mandate" for large employers to provide affordable insurance for employers or pay the penalty.

Evaluate one of the ACA requirements for large employers and how it would apply to a large managed care organization (MCO).
Why would it be important for a large employer to meet the ACA requirements? What are the consequences of non-compliance?

Discuss the COSO framework for internal controls and evaluate how it could be used to meet ACA employer mandate requirements. Be specific and demonstrate understanding of the risks and how the compliance tool can be used specifically to control the risks.

Part 2: Strategic Compliance with the Law

You work for a small managed care organization (MCO) "Splendid Healthcare" that owns a hospital and two provider clinics in. Your MCO has 100 employees and provides health insurance through a contract with a large insurance company "Insurance Inc." Insurance Inc. follows the ACA preventive service requirements and covers influenza vaccines for your employees. Lately, these claims have been rejected by Insurance Inc. You call the Insurer and they request medical records to support the payment request for the 30 employees whose immunization claims were denied. The Insurer says you are billing the incorrect code.

Name and describe the law and give the code section that gives Insurance Inc. have the right to access your medical records. (Give the legal source of the right)
Discuss interoperability requirements. How would you honor the medical record request? What format would you use to share the medical records?
How would you update your EHR billing codes to ensure that future bills for the influenza vaccine are automatically billed correctly?

Reference no: EM133432762

Questions Cloud

Describing fixes for resource leaks : Articles describing fixes for resource leaks, dereference of NULL pointers, incorrect usage of APIs, use of uninitialized data.

Should you tell him his diagnosis explain : The man has just retired from a busy professional career, and he and his wife are about to leave on a round-the-world cruise that they've been planning

Describe the acute and chronic effects of physical activity : describe the acute and chronic effects of physical activity on specific measurable criteria within the human body (e.g., VO2 max, increased Cardiac Output)

Difference between internet torts and traditional torts : How can people protect against these limitations? Include an example that illustrates the difference between internet torts and traditional torts.

Name and describe the law and give the code : Name and describe the law and give the code section that gives Insurance Inc. have the right to access your medical records

Identify the key offering enabling insurance firms : Identify the key offering enabling insurance firms to compete effectively in financial planning. Banking services. Team structure. Guaranteed products

What types of leadership traits have you encountered : What types of leadership traits have you encountered in your experience? What were some quality traits and also some that needed polishing

Is spurious regression a serious concern when running capm : Is spurious regression a serious concern when running CAPM regressions? Please provide detailed explanations for the reasons.

Revenue lost was $7.5m ten years ago and $3m five years ago : time and the highest grossing restaurant was closed for six months each time. Revenue lost was $7.5M ten years ago and $3M five years ago

User Account

All Pages