HIPAA and Medical BillingYacaraDislaAsaCollegeALH205-M01ProfessorTetyana UsenkoFall2017 HIPAA and Medical BillingHIPAA(The Health Insurance Portability and accountability act of 1996) is a legislationproclaimed on August 3, 1996, which primary goal was to “remove the healthcondition from health insurance considerations” to upgrade and refineportability and continuity of the amount of protection given by healthinsurance and combat misuse, fraud, and abuse in health insurance andhealthcare distribution.The legislation was splitup into seven titles:· Title I – Health care access, portability,and renewability.· Title II – Stop Health care fraud andmisuse, administrative simplification, and medical liability reform· Title III – Tax-related health provisions· Title IV – Group health plan requirementsapplication and enforcement.HIPAAensures the protection scope of laborers after they lose or change theiractivity, it secures the protection of patients’ therapeutic data, builds upprinciples for electronic therapeutic exchanges, and sets up the disciplinesfor fake therapeutic revealing practices.HIPAAinstitutionalized medicinal codes and set up the Electronic Data Interchangeframe that we utilize to send asserts electronically; this EDI has variouswritings, each of which compares to a specific type of exchange between asupplier and a payer.Theact states that the motivation of Title II, Administrative Simplification, is toadvance the Medicare and Medicaid plans and the effectiveness of the healthcare system by supporting the development of a health information system viathe establishment of standards and requirements for the electronic transmissionof certain health information. MedicalBillingis the operation of procuring payments for services that healthcareproviders give to patients.
The majority of the US population have some form ofhealth insurance that will pay, to a certain extent, part of the medical bill.The healthcare provider submits the invoice to the insurance institution forpayment. Most medical bills, nowadays, are sent electronically, in which case,the provider sends the needed information in a pre-defined format that theinsurance institution requires. When the insurance company receives a claim, itcan either deny it, settle it or retain it for further information. Anotherimportant entity in the medical billing business is the medical coder, whoaudits the patient’s records to summarize and codify the services that thedoctors supply to patients to make sure that they send accurate codes toinsurance institutions and that they properly process the claims. Codingconveys the entire billing process.