Guidelines for Medical Billing and Coding Comapnies

Guidelines for Medical Billing and Coding Comapnies

Medical billing can be defined as the procedure through which one submits and subsequently follows up the claims with health insurance companies so as to obtain money for the services provided or rendered by a health service provider. Irrespective of whether the company belongs to the public sector or the private sector, the procedure followed is always the same.

Those who work in Medical Billing and coding companies obviously do better if they have a certification obtained through any of the exams like RHIA, CMRS and so on. The schools, which provide such certifications, ensure that these students have deep knowledge of this domain before joining their field of work. Though it is not legally mandatory, but the best medical billing companies prefer certification.

The medical billing companies, also known as the physicians billing companies, follow certain regulations or guidelines. Those involved with medical billing deal with highly sensitive information and deal with health service provider, insurance and patient information which needs to be kept safe and secure at all times. The transfer of medical information between the various components mentioned is also governed by these specialists so it’s imperative on their part to perform duties within the specified guidelines failing which a federal investigation might be on the cards. In the context of medical billing one must also mention Ambulatory Surgery Center (ASC) Billing Instructions which basically comprise billing instructions for healthcare facilities dedicated to provide surgical services to patients in the outpatient setting.

Medical Billing Service

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These guidelines are mentioned in various acts like the Healthcare Reform Act of 2010, the Office of the Inspector General (OIG) and the Health Insurance Portability and Accountability Act (HIPAA), wherein certain guidelines have been prescribed which encompass rules related to privacy and security which is imperative to be known by any entity or a medical billing specialist involved as a professional in top medical billing companies in the domain of physical billing.

The HIPAA provides basically a list of guidelines for collating and transferring patient information. It prescribes with the power of an employer with respect to an employee medical plan provided by the former. Thus, it protects the employees from any violation of the existing medical plan that has been provided. Along with that HIPAA also ensures that the healthcare providers provide proper service to patients, which was however limited previously for those who had an existing condition as it was supposed to be way too risky. HIPAA however made sure that such limitations cease to exist. The title two of HIPAA deals with privacy and security of the patient as well as preventing fraudulent activities of health service providers.

The OIG again is more of a compliance act which makes sure that the entities covered by HIPAA adhere to the privacy and security measures enlisted. It makes sure that the entities covered in HIPAA don’t indulge in fraudulent practices like under coding (leaving out code for service provided), upcoding (assigning higher codes than necessary to explain patient condition), unbundling codes(submission of separate claim to the health insurance provider for services that could be put on one bill) and also the falsification of medical records.

The Healthcare Reform Act of 2010 again ensures higher degrees of protection for those who are enlisted in Medicare and also makes electronic records and transactions mandatory.


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