HIPAA in Medical billing

WHAT IS HIPAA?

President Clinton signed into law the Health Insurance Portability and Accountability Act (HIPAA) on August 21, 1996. The two chief sponsors of the law were Senators Kennedy and Kassebaum, and therefore HIPAA is also referred to as the Kennedy-Kassebaum Act. Do not be misled by the name; this new federal law (P.L. 104-191) applies to many health care market players, not just health plans and insurance companies. It is the most sweeping legislation to affect the health care industry in over thirty years.
HIPAA is comprised of two major legislative actions: Health Insurance Reform and Administrative Simplification. The Health Insurance Reform provisions have been in effect for some time and require implementation of certain practices by health plans and insurers regarding portability and continuity of health coverage. Administrative Simplification mandates standards for electronic data interchange (EDI) and code sets, seeks protections for the privacy and security of patient data and establishes uniform healthcare identifiers.
Early interpretation of the act was earlier focused on its intent of improving health insurance coverage for people who changed or lost their jobs. The health care industry is now recognizing other important ramifications of the act, one of the most significant being the Administrative Simplification provisions (Title II, Sub-title F). The chief intent of these provisions is to streamline, standardize and secure electronic data interchange (EDI) and to further protect the confidentiality of health care information transmitted through any medium.

Comments

What is QMB / MQMB stands for?

In Medical billing or Healthcare industry The term QMB stands for Qualified Medicare Beneficiary & MQMB stands for Medicare Qualified Medicare Beneficiary. The term "QMB" or "MQMB" on the form indicates the client is a Qualified Medicare Beneficiary (QMB) or a Medicaid Qualified Medicare Beneficiary (MQMB). The Medicare Catastrophic Coverage Act of 1988 requires Medicare premiums, deductibles, and coinsurance payments to be paid for individuals who meet the following criteria: Important: Clients limited to QMB are not eligible for THSteps or THSteps-CCP Medicaid benefits. Note: Clients eligible for STAR+PLUS who have Medicare and Medicaid are MQMBs. Medicaid reimburses for the coinsurance and deductibles as well as Medicaid-only services for the MQMB client. QMBs do not receive Medicaid benefits other than Medicare deductible and coinsurance liabilities. MQMBs do qualify for Medicaid benefits not covered by Medicare in addition

Mastering the 'Tell Me About Yourself' Interview Question: Best Tips and Examples

In a job interview, the "Tell me about yourself" question is often asked early on and is an opportunity to make a positive first impression. The key is to provide a comprehensive response that highlights your qualifications and aligns with the job you're applying for. Here's a structured approach to crafting the best answer: Start with a Brief Personal Introduction: Begin by mentioning your name and your current or most recent role, if applicable. For example, "I'm [Your Name], and I'm currently working as a Sr AR Specialist at XYZ Company." Provide a Summary of Your Professional Background: Offer a concise overview of your professional journey, emphasizing the experiences and skills most relevant to the position you're interviewing for. You can mention your years of experience, notable career achievements, and areas of expertise. Highlight Relevant Achievements: Share specific accomplishmen

Rejection Procedure note qualifier is missing

Need to check the Charges tab and double click on the Procedure Code line to open up the Charge Entry window. There is a Notes section on the right hand side. If there is a note typed, we need to select the type. Need to select field and select the appropriate type of note you are sending. Save the changes made Check all the procedure if submitted many procedure. Save the visit again and submit the claim.

Medical Billing

Search This Blog