Specific Claims Procedures Apply To Physician Billing Staff

Therefore, it forces the physician's staff or the hospital billing staff to work

more diligently in order to adjust and conform to all of the perpetual modifications. When specific rules and guidelines are not followed, the question is, what are the regulations that need to be followed so that the physician's offices are in alignment with current guidelines?

Primary Regulating Bodies For Physician Billing

Staff members of medical practices should always be aware of the laws regarding medical billing practices. Primarily, all claims billing must adhere to the following guidelines:

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a vitally important law that regulates confidentiality of patient records. It is also responsible for the efficiency of electronic data transfer, while also protecting the privacy of that exchange.

The Fair Debt Collection Act involves the procedures that must be followed in regards to collecting debt. There are specific guidelines that have to be followed so that staff members know how and when such debt is to be collected. This law focuses on protecting the patient from unlawful and illegal threats made in attempt to collect a debt.

How Is The Physician Billing Process Handled?

The medical claim billing process is vitally important to the sustainability of the medical office. Therefore, it is important for staff members to immediately gather all of the correct patient data that is needed to process the claim, starting from the first office visit. Once all data is collected, such as patient information, insurance data and medical procedures performed, the claim will then be coded to the proper medical procedure and diagnosis categories. Most importantly, all codes must be accurate and properly priced before the claim can be sent out to be paid.

Finally, once the claim is received by the payer, it can either be rejected or paid. If the physician's bill or claim is rejected, then the medical billing staff must determine the cause of the rejection. Once the claim is revised, corrected, and then resubmitted for payment, the payer will submit the claim to settle the account. Furthermore, if there are any accounts that have not been settled, the physician's staff will begin their collections efforts in attempt to get all accounts paid.

by: Christine Harrell

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