Medical Billing Rules

What is the main purpose of medical billing? Well it is just to make sure that the service provider receives a fair payment for services provided and also so that the payment is received in time. The medical billing procedures are governed by certain laws. What are the main laws that govern medical billing? They include the following 3 laws;

Fair debt Collection Act

The Health Insurance Portability and Accountability Act

The Privacy Rule

The Fair debt collection Act is a federal law that dictates how and when a debt is to be collected.

This act is for the protection of all the patients and other consumers from unlawful threats.

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The Health Insurance Portability and Accountability Act of 1996, better known as the HIPAA, was enacted by the U.S. Congress in 1996. It has two titles.

Title I of HIPAA regulates the availability, breadth of group and individual health insurance plans. It amends both the Employee Retirement Income Security Act and the Public Health Service Act. This act also prohibits any group health plan from creating eligibility rules or deciding of insurance premiums for individuals in the plan based on health status, medical history, genetic information, or disability. Thus Title I also protects health insurance of workers and their families if they have to change jobs.

The second title of HIPAA contains a portion that increases the efficiency of data exchange for healthcare financial transactions and protects the privacy of electronic data transmission and the confidentiality of patient records. All medical providers are asked to send their claims electronically in compliance with the act to receive their payment. This includes electronic transmission of major financial and administrative dealings, including billing, electronic claims processing and reimbursement advice. Various offenses relating to health care are set and criminal penalties imposed. Besides creating several programs to control fraud and abuse within the health care system it imposes penalties when rules are violated.

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The privacy rule regulates the use and disclosure of Protected Health Information (PHI). PHI is any information about health status, provision of health care, or payment for health care that can be linked to an individual. Any person who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights.

Source by Ricci Mathew

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