Medical Billing Guidelines

Medical billing and coding specialists deal with sensitive information on a daily basis. As a medical billing and coding specialist, you will handle provider, patient, and insurance information that must be kept secure at all times. You will also be responsible for facilitating the secure electronic and physical transference of sensitive medical information between these parties. Failing to perform your duties within the guidelines may result in a federal investigation.

An overview of guidelines and compliance requirements set by the Health Insurance Portability and Accountability Act (HIPAA), the Office of the Inspector General (OIG), and the Healthcare Reform Act of 2010 follows. The guidelines set forth by these entities comprise some of the most important privacy, security, and filing-related rules you will need to know as a medical billing specialist.

HIPAA Compliance

HIPAA was passed by Congress and signed into law by President Clinton in 1996. Chief among the goals set forth by HIPAA was increased security and accountability when it comes to patient medical information. Specifically, HIPAA established guidelines that healthcare providers and health insurance companies must follow in order to keep a patient’s information secure.

These HIPAA guidelines apply to the gathering, cataloging, and transferring of any and all patient information. For the purposes of medical billing and coding, HIPAA serves to curb fraudulent activity before, during, and after the claims process as well as establishing standards for transferring patient information electronically.

HIPAA is divided into five Titles.

Title I: Healthcare Access, Portability, and Renewability

Title I of HIPAA addresses health insurance policies within the confines of a person’s employment. Under Title I, HIPAA sets guidelines for what an employer can and cannot do with an employee’s healthcare plan as provided by the employer. Specifically, Title I protects health insurance coverage for employees and their dependents by making healthcare plans available to those who have either lost their job or those who are in the process of switching employers.

Title I protects employees by modifying and improving the Consolidated Omnibus Reconciliation Act of 1985 (COBRA). Title I of HIPAA extended healthcare benefits already offered by COBRA, including extending the duration of benefits of disabled persons eligible for COBRA from 18 to 36 months. Title I also allowed dependents of a person covered under COBRA to continue to receive the same healthcare coverage as they did when that person was employed with health benefits.

Title I also addresses how health insurance companies treat patients with pre-existing conditions. Before HIPAA, a person with a pre-existing condition might have trouble finding a healthcare plan that covers their medical expenses because commercial insurance companies would consider them too risky to cover. Under Title I, insurance companies are limited in how many restrictions they can put into place in their healthcare plans for people with pre-existing conditions.

For medical billing and coding professionals, Title I is important because it ensures that more people are eligible for health insurance. Because of the laws set forth in Title I, you will process claims that involve patients covered by COBRA or those with pre-existing conditions that still receive coverage thanks to this act.