XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> Medical Billing and Coding Laws & Regulations | Medical Billing and Coding Class

Medical Billing and Coding Laws & Regulations

medical billing and codingA medical billing and coding specialist is responsible for sorting through and filing a great deal of paperwork and medical information on a daily basis. Acting as a type of middleman between what takes place in the doctor’s office or medical center and the method of payment (which may involve the actual patient or the insurance company), the medical billing and coding specialist has a wide range of duties.

The medical billing and coding specialist handles insurance claims, billing patients, and making sure that all proper paperwork is filled out, properly coded, and that the payee or insurance company is correctly billed. Collections is also, at times, one of the responsibilities of the medical billing and coding specialist.

If you are thinking about becoming a medical billing and coding specialist, there is much to be learned, but once you’ve completed proper training, a career as a medical billing and coding specialist can be fulfilling and financially rewarding.

Latest News Regarding Medical Billing and Coding Regulations

What can go wrong with a medical billing and coding career? Unfortunately, this profession remains largely unregulated. First of all, although certification is advised, it is not required in order for a medical billing and coding specialist to practice in the field. So, who makes the rules and regulates the performance of medical billing and coding specialists? Generally, this task is left up to the employer, physician’s office, or medical facility that decides to hire an independent contractor to handle their bills. It is completely up to them to decide whether or not they require the biller and coder to be certified, have a degree, or even have a certain amount of experience under their belt.

Is this frame of mind a mistake waiting to happen? Probably so, and because of the very lenient regulations currently surrounding medical billers and coders, things may soon change.

According to the National Inpatient Coder Survey which took place in 1999, only half of all medical billers and coders in the United States were certified. This, of course, raised a certain amount of concern. It has been brought to the attention of the government that certification should be mandatory and that certified medical billers and coders should have specific quality assurance regulations to govern their actions.

When Will Changes in the Industry Take Place?

The United States government is currently moving toward full credential requirements for all medical billers and coders. Anything that has to do with the health care field involves sensitive and private information and should, of course, be handled properly.

A Word on Medical Billing and Coding Fraud & Abuse

One of the reasons why stricter regulations are sure to come, is because of the possibility of fraud and abuse in this field.

A law was passed in 1998, stating that a hospital or medical facility engaging in fraudulent insurance claims, was liable for triple the amount of damages has put the brakes on certain fraudulent activity, but, it has become clear that more protection is in order. Unscrupulous medical billers and coders have been accused of:

  • Providing payment for unnecessary medical services
  • Billing and collecting for services not rendered
  • Upcoding (which involves coding the procedure at a higher level in order to collect more payment)
  • Duplicate billing
  • Failure to refund credit balances to companies

Is the information provided above unfortunate? Absolutely. Do we think that stricter rules and regulations are in the future of the industry? Yes we do. We hope you use this information to make the decision to operate in absolute integrity in your new career as a medical billing and coding specialist.

Comments are closed.

Premium Wordpress Plugin