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.

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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 ...

Key Performance Indicators (KPIs) for Successful Revenue Cycle Management (RCM) in Healthcare Organizations

Revenue Cycle Management (RCM) is an essential process for healthcare organizations to ensure that they receive timely and accurate payments for the services they provide. Here are some of the key performance indicators (KPIs) metrics that healthcare organizations should track as part of their RCM process: Gross Collection Rate (GCR): This metric measures the percentage of charges that a healthcare organization collects from patients and insurance companies. It is calculated by dividing the total payments received by the total charges billed. Net Collection Rate (NCR): The NCR measures the percentage of expected payments received by the healthcare organization after accounting for contractual adjustments, bad debts, and other adjustments. It is calculated by dividing the total payments received by the total expected payments. Days in Accounts Receivable (DAR): This metric measures the average number of days it takes fo...

What is W-9 form? Why it is required for Medical Billing.

W-9 Form W-9 is Internal Revenue Services (IRS) request for Tax Payers identification number, mainly its used for third parties to collect ID information like Name, Address to help file information returns with IRS. Also its is used to help payee avoid backup withholding. It is required for your name, Address and SSN number or employer identification number. When your giving out W-9 form be caution, because W-9 form contains sensitive information’s. Why Insurance Company ask W-9 Form from hospital or clinic etc., Because medical billing is cycle indirectly or directly insurance company’s are working for hospital or clinic etc., for them we need to report SSN number / business tax id. As far as W-9 is form is concern it is straight forward with the all the above mentioned information, also they need to pay to address, or to update their records, or to check / update records. Note: W-4 Form is used by employer ...

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