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Medical Billing and HIPAA: How One Changed the Other

March 30, 2012 | Comments: 0 | Views: 106

Even before the excitement that resulted while the ICD-10 was being proposed, the medical billing process has had to stay afloat while undergoing a series of constant changes. One large proponent of this change was started seven years ago. That year, the Health Insurance Portability and Accountability Act (or HIPAA) was introduced, and almost immediately it began presenting challenges to the field of medical billing. It is a system of guidelines and regulations that must be followed by doctors, health care providers, health care insurance plans, and facilities so that they may provide their services effectively and avoid breaches of confidence while keeping patient records up to date. Ever since 2005, professionals in the medical field have been strongly encouraged to send their claims electronically, as this keeps in compliance with HIPAA regulations. While meant to ensure the ethics and accountability of health care industry professionals, the HIPAA is of course not without its share of flaws.

The titles in HIPAA are vitally important for the knowledge and effective performance of any medical biller. The first Title of this act is intended to protect the health insurance coverage of employees and families during change or loss of a job. It places a regulation on the spectrum of available health plans and a number of individual health insurance policies, and has had a great effect in amending the Public Health Service Act, the Employee Retirement Income Security Act, and even the Internal Revenue Code. Title I has also limited restrictions that a health care plan for a group can place on the benefits or preexisting conditions.

The most relevant section to medical billers is found in reading the second Title. There, a number of offenses are listed that are related to health care, and the corresponding legal penalties for infringing on them. Title II also has made an array of regulating programs that kept fraudulent, abusive activity under control in the health care industry. The strongest aspect of Title II's provisions are its rules for Administrative Simplification. Because of them, the Department of Health and Human Services is required to create rules meant to increase the health care system's overall efficiency. These rules are directed specifically at "covered entities", or health care plans and billing services, and include the Privacy, Security, Unique Identifiers, Enforcement, Code Sets, and Transactions Rules. Since then, the billing systems in medical facilities have been subject to a welcome method of organization and guidelines for its operations.

The HIPAA provided a new set of ordering rules and ethics for the medical industry, but it also resulted in a larger amount of patient paperwork. Since then, government administrators have been faced with the difficult task of creating rules for regulation that affect the patient as minimally as possible, and the results still do not always work entirely in the patients' favor. It now also rests on the health care professional to obtain a clear understanding of these forms and waivers, so that the medical billing process may be as fast and efficient as is possible.

George Kagan is a lead marketing copywriter for a Medical Billing School. Allied provides medical training programs that prepare students for careers in the medical coding, billing and medical transcription fields. Online courses offer students a quick and convenient way to learn.

Source: EzineArticles
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