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Federal Health Care Billing Requirements

Medical billing is a specialized area. People wishing to work in the medical billing industry work either for themselves or for a health care organization. As of 2010 it is not compulsory to take an examination, but many billers choose to take the Certified Medical Reimbursement Examination (CMRS). According to proposed health reform all medical data will have to be digitized by 2014.

  1. Privacy Policy

    • All handling of medical records is addressed by HIPAA.

      The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the first comprehensive federal legislation on patients' privacy. It increased the responsibilities of health care practices, billers and insurance companies regarding the confidentiality of patients' medical records. Each biller has to develop a privacy policy for all its handling of patients' health information.

    Confidentiality Plan

    • Each health care center must have a confidentiality plan, which must cover administrative safeguards; physical safeguards; security services and security mechanisms. The doctor begins the billing process when the patient is first seen. Both the level of service and the diagnosis are entered into a database. The code for the level of service is drawn from the current procedural terminology database. The verbal diagnosis is drawn from a standard ICD-9-CM database. Both of these are vital for claims processing.

    Patients' Records

    • Patients' health information is subject to both the federal Privacy Rule (detailing who can and cannot see patients' information and a patient's own right to his own records), and the federal Security Rule, (detailing how records must be stored). Insurance companies must comply with the Fair Credit Reporting Act (FCRA) when making decisions about patients' bills. This legislation demands fairness, privacy and accuracy. Information given to the insurers by credit rating agencies must be accurate, and this in itself must not decide whether an insurance company pays or declines to pay for medical care.

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