Medical Billing

Health Insurance Portability and Accountability Act, shortly HIPAA of 1996. Title one - Protects health insurance coverage for workers and their family when employees change their job Title two- Electronic Health care making administration simplification & NPI This rule was signed by President Bill Clinton. Health Insurance Portability and Accountability Act Everybody knows about health insurance, In HIPAA what is Portability means? In general portability means easily accessible or Movable in HIPAA Health care is portable. Who is accountable Who are all involving in billing cycle they are all accountable under HIPPA. Penalties Under HIPAA 42USC1320d-5 General penalty for failure to comply with requirements and standards (a) General penalty (1) In general Except as provided in subsection (b), the Secretary shall impose on any person who violates a provision of this part a penalty of not more than $100 for each such ...

CLIA stand for Clinical Laboratory Improvement Amendments, According to CMS CLIA covers 239,000 entities and Centre for Clinical Standards and Quality responsible for implementing CLIA programe. Types of CLIA Certification There are five different type certificates may issued to providers. Types are as follows. Certificate of waiver – Issued to a laboratory to perform only waived tests (Eg simple examinations or procedures that use methodologies that are so simple and accurate that the likelihood of erroneous results is negligible and poses no reasonable risk of harm to the patient if the test is performed incorrectly).  Certificate for Provider-Performed Microscopy Procedures (PPMP) – Issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedure (a procedure categorized as moderately complex where the primary instrument for per- forming the test is a microscope). This certificate permits th...

Following are list of services that required Authorization, again it will differ from insurance to insurance, below are the most common list. So please refer your insurance documentation for particular requirement. Inpatient and Observation Admissions, as noted above Admission to any rehabilitation and skilled nursing facility All surgical procedures, inpatient or outpatient The following have special reporting requirements (refer to Forms Section):   Abortions   Hysterectomies   Sterilization procedures Cosmetic or Reconstructive Surgery, including but not limited to:   Breast reconstruction or reduction   Blepharoplasty   Venous procedures   Sclerotherapy Services and items:   Allergy (immunotherapy), exept for those services identified on the QAF   Ambulance transportation (non emergent)   Amniocentesis   Cardiac and pulmonary rehabilitation programs   Circumcisions after 12 weeks of age   Co...

80061 Lipid panel [this panel must include the following:     · Cholesterol, serum, total (82465) · Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) · Triglycerides (84478)]. Lipid panel provides direct testing of high density lipids (HDL), cholesterol, and triglycerides. The report of this lipid panel includes a "calculated" value for low density lipids (LDL). This means that the lipid panel tests three lipid fractions but is able to report four values.

98940 Chiropractic manipulative treatment (CMT); spinal, one to two regions 98941 spinal, three to four regions 98942 spinal, five regions Doctor adjusts only upper cervical, the appropriate CPT is 98940 Doctor adjusts full spine cervical, thoracic and lumbar CPT code 98941 Doctor who use five regions for that we need to use CPT 98942