Medical billing is the process of collecting fees for medical services from health insurance companies, government programs, and patients. A medical bill is called a claim. Medical billing and coding is often done by specialists in the field.
PurposeThe purpose of medical billing is to ensure that the provider receives fair payment for services rendered. Payment should reflect the services performed and should be received in a timely manner.
Medical billing in the United States is extremely complicated due to the nation's system of health insurance. Providers collect fees from many different insurance companies, which negotiate their own deals with different clients, the details of which can change annually. They also must collect from government programs such as Medicare and Medicaid, which offer different plans. Patients themselves are responsible for some portions of their medical costs, including co-pays at the time of service, deductibles every year, and coinsurance paid on particular services. The whole system requires a great deal of manpower, arcane codes, specialized computer systems, and regular training to keep up with changes.
PrecautionsSeveral laws regulate medical billing procedures. Staff members involved in collecting fees must be aware of these regulations.
Some of these laws are:
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The Fair Debt Collection Practices Act (FDCPA). This federal law dictates how and when to collect a debt. It protects patients and consumers from unlawful threats.
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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) contains an administrative portion that increases the efficiency of data exchange for healthcare financial transactions and protects the privacy of electronic data transmission. This protection is especially important for confidential patient records. Violators are subject to financial penalties.
