What is HIPAA?
Created in 1996, HIPAA is an act of Congress that protects the health insurance of workers and their families if they lose their jobs. HIPAA also protects the privacy of children 12 to 18 years of age and establishes a number of regulations for the electronic transfer of healthcare data.
HIPAA is divided into five sections, or Titles. We’ll focus only on the first two Titles, which are the largest and most far-reaching.
Title I establishes rules for how group health organizations (like managed care organizations) interact with patients. Title I limits the restrictions a group health organization can put into place based solely on a pre-existing condition.
Title I also limits the amount of time it takes to get coverage for that pre-existing condition. Specifically, once a person has coverage under a group health organization, that person must receive coverage for their pre-existing condition within 12 months (or 18 months in certain circumstances).
Title I also provides protection to individuals and their families when that individual changes or loses their job. If an individual has health insurance under their old job, they are allowed to keep that insurance until the point when their new health care coverage kicks in. There are a few caveats to this, of course, and HIPAA does not provide permanent health insurance. It does, however, ensure that persons out of work can continue their health care coverage while in between jobs.
As you may be able to tell, this Title of HIPAA affects insurance companies and their interactions with patients much more than it does medical billers. Title II is where we’ll see HIPAA affect medical billing more directly.
When HIPAA was passed, an increasing number of medical transactions were being performed electronically. While electronic transactions (like claims) were faster, more cost-efficient, and less error-prone, they also caused some patients and regulators to worry about the privacy of the personal medical records. Title II addresses these concerns and establishes standards and guidelines for these types of transactions.
Privacy and Security
Title II lays out a set of security guidelines that ensure the safety of both physical and electronic records. These regulations limits who can view medical information, and also dictates how this information is transferred.
Title II also established a set of rules limiting who can distribute your medical information, and when. These rules give patients more control over their medical records, including who can access them and at what times. These rules prevent anyone–including providers, payers, or government agencies–from viewing or distributing a patient’s medical information for anything not related to treatment for the patient. For instance, on a worker’s compensation claim for a broken finger, a biller would not include the patient’s history of heart disease.
HOW HIPPA AFFECTS THE PRACTICE OF MEDICAL BILLING?
Whether you know it or not, you’re actually already familiar with many of the provisions laid out by HIPAA. One of the most readily felt impacts of HIPAA is the standardization of medical codes used by coders and billers.
HIPAA formalized the use of ICD codes for diagnosis and CPT and HCPCS codes for procedural reporting. We use these codes every day in medical billing to create claims.
HIPAA establishes and manages electronic medical transactions. Title II of HIPAA requires all providers and billers covered by HIPAA to submit claims electronically using the approved format.
MEDICAL BILLING VIRGINIA offers your medical practice exceptional customer service, HIPAA compliance, and the latest in medical billing technology. We are flexible to work with your existing system.
Medical Billing Virginia is such a kind of team which has half people working on-site in America itself and half of the employees are in India. This may be the reason for our one of the punch line that “We work on your project round-the-clock.” “We are available here in person” to discuss your business model, understand your internal work flow, help to resolve your issues quickly.
With Medical Billing Virginia Discover all the ways to Lift up your Practice while Saving Time!
IT’S YOUR TURN — NO APPOINTMENT NECESSARY! CALL US AND HAVE YOUR CONSULTATION TODAY!
By geralt from Pixabay