Federal Requirements Essential For Medical Billing Services In USA

Medical billing services constitute an integral part of healthcare for all medical facilities. They equally benefit providers whether they are a solo practitioner or working as a part of an organization. The medical billing and coding services help them all in collecting revenue payments. They collect patient care information from providers and make a bill. Then, forward it to the clearinghouse for approval. Therefore, every provider wants to outsource these services from a reputable medical billing company in the USA.

Anyhow, it is true medical billing professionals don't have to directly interact with the patients. But they perform various healthcare administrative roles. So, every medical billing service in USA obeys the same set of strict compliance rules with little or no difference.

Here in this blog, we will check out some federal requirements for practicing medical billing services in the US.

Confidentiality Law for Respecting the Patient’s Privacy

Patients when visiting their providers share their demographic information at the front desk. A provider deals with them. Then, the details regarding the services rendered to them are compiled for billing and coding. That’s how billing companies get access to the health-claim data of an organization.

The U.S. government has devised several rules for human rights and confidentiality is one among them. So, the U.S. Congress has not neglected the patients’ privacy rights in healthcare as well. It was 1996 when it constituted a confidentiality law named HIPAA. HIPAA stands for the ‘Health Insurance Portability and Accountability Act’. This law doesn’t allow any authorized person to have access to a patient’s data except the concerned entities. So, all healthcare organizations have followed this law. And resultantly, they have maintained strict data security systems for standard compliance models.

So, HIPAA applies to medical billing companies in USA that deal with inbound claims. Any medical biller and coder cannot disclose a patient's information wrongly. They must implement all patient privacy rules in their billing processes and operating policies.

Medical Fraud; A Serious Federal Crime

Performing medical billing and coding is an exhausting job at times. Suppose you wake up and do complex coding all day. Errors in medical coding become obvious when a coder gets tired as they are dealing with constant pressure. And coding errors occur more frequently when the coder is not trained much. This might cause medical fraud due to the processing of a fraudulent healthcare claim.

Here let us inform you that medical fraud in any case can put you in huge trouble. The U.S. government can give financial penalties for this. In 2007, National Health Care Anti-Fraud Association claimed the processing of 7 billion healthcare claims. It was found that many of these claims were major medical frauds. After that, they took strict actions to avoid such fraudulent activities in healthcare.

Usually, we question medical billing services directly when:

●     Claims do not have clear details about a service delivered to the patient

●     any under-coding or over-coding issue occurs

●     Have any changing/manipulations in medical claims i.e., false date and time, etc.

Therefore, a medical billing company should train its team. They might be informed of the significant repercussions of fraud through annual ethics training. Also, they need to be aware of what is considered medical fraud and abuse so that they do not face any trouble for their carelessness.

Fair Debt Collection Practices Act for Financial Stability

Subsequent delays in claims processing by irresponsible medical billing and coding services. This takes the shape of bad debts eventually if not handled on time. However, U.S. Federal Trade Commission has forwarded the Fair Debt Collection Practices Act in 1978. This law prohibits any false or abusive act for collecting money.

This happens many times in healthcare where the service provided to patients is not covered by the payer's insurance program. To avoid such cases, a prior-authorization step before the treatment can be helpful. They can check for insurance companies and its program before giving the treatment. Otherwise, when a medical billing company forwards such a claim, the payer rejects it. As a result, patients have to pay it out of their pocket. It could be difficult due to their low financial condition.

Here the Fair Debt Collection Practices Act supports all such people. Medical billing services providers are prohibited from threatening or harassing patients to collect payments under this law. Because of this, billing companies might use various methods of money collection. For example, they can make a repayment schedule that is more comfortable for them financially.

Conclusion

The US government has made several federal rules to upgrade healthcare. They have provided several rules that must be implemented in all practices. Being a part of the healthcare system, every medical billing and coding service provider must stick to federal requirements. 

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