Medical Billing Rules
What is the main purpose of medical billing? Well it is just to make sure that the service provider receives a fair payment for services provided and also so that the payment is received in time. The medical billing procedures are governed by certain laws. What are the main laws that govern medical billing? They include the following 3 laws;
Fair debt Collection Act
The Health Insurance Portability and Accountability Act
The Privacy Rule
The Fair debt collection Act is a federal law that dictates how and when a debt is to be collected.
This act is for the protection of all the patients and other consumers from unlawful threats.
The Health Insurance Portability and Accountability Act of 1996, better known as the HIPAA, was enacted by the U.S. Congress in 1996. It has two titles.
Title I of HIPAA regulates the availability, breadth of group and individual health insurance plans. It amends both the Employee Retirement Income Security Act and the Public Health Service Act. This act also prohibits any group health plan from creating eligibility rules or deciding of insurance premiums for individuals in the plan based on health status, medical history, genetic information, or disability. Thus Title I also protects health insurance of workers and their families if they have to change jobs.
The second title of HIPAA contains a portion that increases the efficiency of data exchange for healthcare financial transactions and protects the privacy of electronic data transmission and the confidentiality of patient records. All medical providers are asked to send their claims electronically in compliance with the act to receive their payment. This includes electronic transmission of major financial and administrative dealings, including billing, electronic claims processing and reimbursement advice. Various offenses relating to health care are set and criminal penalties imposed. Besides creating several programs to control fraud and abuse within the health care system it imposes penalties when rules are violated.
The privacy rule regulates the use and disclosure of Protected Health Information (PHI). PHI is any information about health status, provision of health care, or payment for health care that can be linked to an individual. Any person who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights.
Medical Assistant Certifications, RMA and CMA
Medical assistant certification is voluntary, as it is not required by law for a working medical assistant to be certified. Some employers do require certification as a pre-requisite for employment. Additionally, some of the job tasks of medical assistants require certification by some states. These may include performing x-rays and drawing blood.
There two separate types of medical assistant certification. One is Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA).
Both of these certifications require graduation from an accredited medical assistant program. The program must be accredited wither by the Accrediting Bureau of Health Education Schools (ABHES) or the Commission on Accreditation of Allied Health Programs (CAAHEP).
The American Association of Medical Assistants (AAMA) is the institution that awards CMA’s. In order to obtain a CMA (AAMA) you must graduate from an accredited medical assisting program and pass the CMA (AAMA) Certification/Recertification Examination.
An accredited medical assisting program will include training in the following areas:
o Human anatomy, physiology and pathology
o Medical terminology
o Keyboarding and computer applications
o Recordkeeping and accounting
o Coding and insurance processing
o Laboratory techniques
o Clinical and diagnostic procedures
o Pharmacology
o Medication administration
o First aid
o Office practices
o Patient relations
o Medical law and ethics
Once you complete a training program you can schedule and complete the certification exam.
The AMAA website has helpful information about finding an accredited program and everything you need to know about the exam.
The American Medical Technologists (AMT) awards RMA’s. To receive an RMA you must have the pre-requisites, submit an application to take the RMA exam, and of course pass the examThe pre-requisites are:
1. you must be of good moral character
2. meet one of the 3 following requirements
a. applicant must be a recent graduate from an accredited medical assistant program or a formal medical services training program of the United States Armed Forces;
b. applicant must have been employed as a medical assistant for 5 years; or
c. applicant has passed a generalist medical assistant certification examination offered by another medical assisting certification body.
For more detailed information about the receiving RMA (AMT) certification, visit AMT’s website.
Medical Billing and Coding Salary
Medical billing and coding are two very important careers in the medical field. Billing and coding specialists work together to handle the critical areas of medical sector including; billing, coding, medical office management and processing insurance claims.
Medical submission and coding professionals earn salaries according to their training, experience, skill and location of employment. On average, the salaries of an entry level billing specialist is around $25,000 and for the more experienced coding professional is can be upwards of $50,000. These wages are in USD and are nothing to be ashamed of in these current economic conditions this world is in.
Billing and coding professionals who have gained knowledge through a certified degree program are known as specialists in their field. A certified medical billing and coding specialist can have a variety of job options to choose from due to their educational background. Their highly developed skills allow them to enjoy lucrative income more so than just someone who works at an office without any kind of certification. Their salary goes as high as $50,000 per year at an entry level point and as the promotions come so does an increase in salary.
The wages of billing and coding specialists can vary within different organizations. Billing and coding specialists are mostly hired through hospitals, insurance companies, pharmacies and doctor’s offices. A health care office with numerous patients can give a better starting salary when compared to a small doctor’s office. Medical billing and coding specialists usually work in an office setting and are paid some kind of fixed salary. However, they can be contracted out to work from home and these medical specialists who work as independent contractors can earn an hourly average of $10-$12.
The geographical area of work also has impact on salary. Medical billing and coding professionals who work in big cities earn better when compared to the professionals in the smaller cities. Medical billing and coding specialists who have their own business or company have limitless earning potential.
Medical Billing & Coding is one of the fastest growing careers in today’s world. Health care professionals depend on well trained, reliable and experienced billing and coding staff because any error in the billing and coding could lead to financial disasters and huge penalties. So, efficient, experienced and trained medical billing and coding professionals are always in demand.