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Medical billing procedures are governed by certain laws. Those who work in this field and directly involved in collecting the medical fees have especially got to be aware of these basic rules and regulations. What is the main purpose of medical billing? Well it is just to make sure that the service provider receives fair payment for services provided and also that payment is received in time. What are main laws that govern medical billing? They include,

  • 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 should a debt is to be collected. This act is for protection of the patients and consumers from unlawful threats.

The Health Insurance Portability and Accountability Act of 1996 which is better known as the HIPAA was enacted by the U.S. Congress in 1996. HIPAA has two titles.

Title I of HIPAA regulates the availability and 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.

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. If the HIPPA rules are violated, penalties can be imposed. Title II of HIPAA defines numerous offenses relating to health care and sets civil and criminal penalties for them. It also creates several programs to control fraud and abuse within the health care system.

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 (OCR).

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