ABSTRACT
Introduction The number, type, diversity, and complexity of CBR compliance opportunities and problems seem almost endless. The magnitude of potential compliance concerns derives directly from the complexity of coding, billing, filing claims, generating itemized statements, receiving reimbursement, and monitoring managed care activities. Moving beyond the claims filing process, the provision of healthcare in different settings has also become more complex. CMS developed the provider-based rule (PBR) in response to perceived abuses of increased payments. EMTALA was developed in response to problems encountered with providing emergency services, some of which impact coding, billing, and reimbursement. Additionally, HIPAA legislation set significant compliance requirements for privacy, the standardization of claims filing, and the use of standard code sets.
