Act establishing health insurance portability and accountability
Published: 2023-02-07 19:20:21

Congress approved the Health Insurance Portability and Accountability Act (HIPAA) to provide patients access to their medical records and to safeguard patient privacy in [medical coding services](https://medsitnexus.com/services/medical-billing-and-coding-services/). All clients must sign a notification attesting that the provider informed them of their rights, and all staff members must sign a confidentiality agreement attesting that they are aware of the need to maintain patient confidentiality and the consequences of breaking HIPAA.
HIPAA also requires patients to list any other people (such as a spouse or parent) who can view their medical records. Any communication a doctor has with a patient is protected by HIPAA, and unless the patient specifically authorizes it in writing, information about that conversation cannot be placed on an answering machine or voicemail.

**CMS stands for the Centers for Medicare & Medicaid Services.**
The United States Department of Health & Human Services (HHS) has a section called the Centers for Medicare & Medicaid Services (CMS). The most vulnerable sections of the population are served by the Medicare, Medicaid, and Children's Health Insurance Programs, which are all administered by CMS. In addition to treating these populations, CMS also establishes healthcare standards, and many private payers adhere to CMS payment policies. Chapters 6 through 17 of the CMS report provide detailed information on their Medicare and Medicaid programs.
10 Pointers from Billing and Coding Experts
The section of the book where unsolicited counsel is given is at this point. That kind of advice is typically unwanted, such as when your in-laws make childrearing suggestions without your permission. But given that it comes from experienced professionals who have traveled the same road as you are currently, I'm willing to wager that you'll find this particular type of impromptu advice useful. Consider the advice in this chapter as your own private coffee klatch, but without the coffee. Here are five pointers to help you stay sane while you're buried in code.

**Demand adequate documentation**
Prior to admission, when the patient fills out the demographic form, the provider confirms their insurance coverage, and the revenue cycle starts. When the doctor finishes recording the patient interaction in his or her records, the cycle resumes. The success of your employment ultimately depends on everyone engaged recording the appropriate information at the appropriate time. If done properly, this preparation lays the groundwork for accurate claims processing and payment. You must ensure that everyone concerned is aware of the required documents and collaborates as a team to achieve that goal in order to obtain the information you need.

**Assess Patient Benefits**
You don't want any unpleasant surprises when it comes to paying medical bills (for payers, payers' patients, and providers). Call the payer to confirm any outstanding copayments, deductibles, or coinsurance obligations in order to prevent awkward "Gotcha!" situations. Collect these funds from the patient before admission. Additionally, confirm whether any scheduled operations require prior authorization. Before the patient even enters the provider's office, your aim should be to get all of this data.

**At check-in, obtain important patient information.**
Obtain a copy of the insurance card and the patient's arrival information, including name, address, date of birth, phone number, marital status, employer, and Social Security number. When the time comes to code and submit the claim, you will need this information.
Moreover, confirm the patient's identification. If your office does not already have a policy in place, consider implementing one that requires all patients to provide identification from the government upon arrival. Make a duplicate of the ID and keep it on file. Forgetting to request a photo ID shouldn't leave you holding the bag.

**ASAP, go over the paperwork.**
You rely on the documentation in your role as a biller/coder. Along with the necessary demographic data, it contains the doctor's comments on the diagnosis and recommended course of action. Despite the fact that you technically have a few days until you must code and submit the claim, act quickly. The claim should be submitted within 72 hours as per your objective. As soon as you can following the visit or operation, review the medical records to make sure they are all there and up to date. And ask the doctor as soon as you can if there are any questions or ambiguities that need to be clarified.

**A System Should Be Set Up To Ensure Accuracy**
From coding to reimbursement, the biller/coder must complete a number of tasks, including abstracting all billable codes and supporting diagnosis codes from the record for the [dental billing company](http://medsdental.com/), entering the claim into the billing software in order to prepare it for submission, submitting it, checking the clearinghouse submission reports, and following up on any issues or denials. You need to be accurate and effective to execute this work properly.
Your ability to manage your time effectively will depend on the organizational structure of the office. Sending the claim to the payer is your main responsibility; the next step is to check if it was received and is being handled. Appealing incorrectly paid claims is your back-end responsibility. Plan accordingly if your daily schedule includes billing and coding in the morning and following up with patients in the afternoon.