Medical Coding and HIPAA
Medical billing and coding students may be trained to complete health insurance claim forms, take down medical documentation, handle billing management, employ software for data exchange, and ensure government compliance.
In handling the latter, coders are faced with a wide range of insurance reporting codes and classifications to identify. In coding for the billing of Medicare and Medicaid services, for example, you may need to know how to find Health and Human Services classification codes for diseases, injuries, impairments, causes, prevention, diagnosis, treatment, and management. There are also codes for provider services by physicians, occupational therapists, radiologists, clinical laboratories, and transportation services. And that's just for starters.
One of the major concerns facing all who process claims and reports is compliance with The Health Insurance Portability and Accountability Act (HIPAA), enacted by Congress in 1996. Your school will probably give you a solid foundation in information transfer and personal privacy protected under the law. But here are some quick refreshers:
What is HIPAA?
The Health Insurance Portability and Accountability Act has two critical provisions. The first protects coverage for workers and dependents if they change or lose their jobs. The second provision, which affects you, is the one that establishes regulatory standards for all electronic transactions between providers, health insurance companies, and employers.
What do the Protections Cover?
HIPAA guidelines specifically apply to any information that providers (doctors, clinicians, nurses, therapists, etc.) put in a medical file. These include conversations between providers, histories, and billing information. It cannot be shared without a patient's consent, typically recorded at the time of service. The law requires all coders and billing personnel to use uniform codes for all transactions, code sets, and so-called identifiers.
What Should You Know?
A comprehensive training program may typically offer a HIPAA overview on portability, accountability, unique identifiers and standards, administrative and technical safeguards, security, and electronic signature standards.
For information on the law and compliance, visit: