FAQs

Medical billing is a payment process within the United States healthcare system that is used by doctors and other healthcare providers and insurers to get insurance claims paid.

Medical coding is the transformation of healthcare diagnoses, procedures, medical services, and equipment into universal medical alphanumeric codes

As a covered entity, the Medical Billing Company is required to abide by all HIPAA rules and laws. We do not store our data on any local file servers, and your data is secure in accordance with HIPAA, HITECH, and OIG guidelines.

In order to build a medical billing team or company. The team should consist of a certified medical coder and a certified medical biller. This is to avoid negligence and mistakes when processing the bill with the corresponding insurance company. Proper training and education should be necessary for the biller and coder to avoid future lawsuits from insurance companies.

Medical Billing is one of the largest systems in the healthcare network, consisting of three major types:

• Open
• Closed
• Isolated

Closed medical billing services mean that the system is only focused on a singular practice. On the other hand, an open billing system allows the transfer of documentation/data across practices, healthcare professionals and facilities, etc. Whereas, the system that is completely removed from the healthcare facilities, physicians, and practices is known as an isolated billing system. Personal Health Records are one such example.

No matter what type of system you are used to working in, it is our responsibility to get your records sorted as per the latest industry standards and help you get more reimbursements.

• We have been in the medical billing business for many years, providing our clients with a positive experience. We’ve mastered the art of keeping customers happy and are constantly striving to do better with each customer. We understand how to effectively communicate with insurance companies and independent payers in order to obtain timely reimbursements.
• We understand that speed and availability are the most important factors for most healthcare providers. Revenue generation and happy patients are what keep healthcare providers afloat. Our team of experts is always available to answer your questions so that you can provide the information your patients require.
• We are a fully HIPAA compliant company. To protect your interests, work with an ISO-certified provider who complies with the Health Insurance Portability and Transparency Act (HIPAA). This gives you peace of mind because our operations follow HIPAA regulations and all of your confidential patient information is kept secure.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement the requirements of HIPAA.

HIPAA Privacy Rule

• address the use and disclosure of individuals’ health information (known as protected health information or PHI)
• These individuals and organizations are called “covered entities.”
• contains standards for individuals’ rights to understand and control how their health information is used.
• A major goal of the Privacy Rule is to make sure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high-quality healthcare, and to protect the public’s health and well-being.

Individuals and organizations are subject to the Privacy Rule and considered covered entities:

• Healthcare providers – who electronically transmits health information in connection with certain transactions. These transactions include:

– Claims
– Benefit eligibility inquiries
– Referral authorization requests
– Other transactions for which HHS has established standards under the HIPAA
– Transactions Rule.

• Health plans – include: 

– Health, dental, vision, and prescription drug insurers
– Health maintenance organizations (HMOs)
– Medicare, Medicaid, Medicare+Choice, and Medicare supplement insurers
– Long-term care insurers
– Employer-sponsored group health plans
– Government- and church-sponsored health plans
– Multiemployer health plans

• Healthcare clearinghouses – will receive individually identifiable health information only when they are providing these processing services to a health plan or healthcare provider as a business associate.
• Business associates– Person or organization (other than a covered entity’s employee) using or disclosing personally identifiable health information to execute or provide duties, activities, or services for a covered entity.

Permitted Uses and Disclosures

• Disclosure to the individual (if the information is required for access or accounting of disclosures, the entity MUST disclose to the individual)
• Treatment, payment, and healthcare operations
• Opportunity to agree or object to the disclosure of PHI
  • An entity can obtain informal permission by asking the individual outright, or by circumstances that clearly give the individual the opportunity to agree, acquiesce, or object
• Incident to an otherwise permitted use and disclosure
• Limited dataset for research, public health, or healthcare operations
• Public interest and benefit activities—The Privacy Rule permits use and disclosure of PHI, without an individual’s authorization or permission, for 12 national priority purposes:
  1. When required by law
  2. Public health activities
  3. Victims of abuse or neglect or domestic violence
  4. Health oversight activities
  5. Judicial and administrative proceedings
  6. Law enforcement
  7. Functions (such as identification) concerning deceased persons
  8. Cadaveric organ, eye, or tissue donation
  9. Research, under certain conditions
  10. To prevent or lessen a serious threat to health or safety
  11. Essential government functions
  12. Workers’ compensation

HIPAA Security Rule

To comply with the HIPAA Security Rule, all covered entities must:

• Ensure the confidentiality, integrity, and availability of all e-PHI
• Detect and safeguard against anticipated threats to the security of the information
• Protect against anticipated impermissible uses or disclosures that are not allowed by the rule
• Certify compliance by their workforce