Specific laws are in place for medical billing to ensure that the health care provider is fairly, and reliably compensated for the work they have done. There are three main federal laws that regulate medical billing.
- The Privacy Rule
- HIPAA (he Health Insurance Portability and Accountability Act)
- Fair Debt Collection Act
States can and do have their own rules that are in addition to those provided by federal law. For the purpose of this article we are going to concentrate on the federal laws mentioned above.
- The Privacy Rule
- This is a set of national standards enacted to protect any information about an individual persons health care. It applies to -
- Health plans
- Health care clearing houses
- Health care transaction conducted electronically
The Privacy Rule sets in place safeguards to protect personal health information, sets limits and conditions on the way that information can be used, and establishes what can be done with that information without a patients authorization. If you ever want to examine your medical records, have a copy of them, or have corrections made this is the law that governs your request.
- The Health Insurance Portability and Accountability Act
- HIPAA, enacted under federal law in 1996 is comprised of two part:
- HIPAA: Title 1
- Regulates group health insurance plans and some individual health insurance plans. For instance it puts restrictions on what preexisting conditions can be refused under coverage. Some long term or limited health care plans are exempt from Title 1 of HIPPA
- HIPAA: Title 2
- Title 2 sets civil and criminal penalties for offenses defined by HIPAA. It has several programs to help control fraud and abuse within the health care system. It also sets up Administrative Simplification Rules which are designed to establish:
- National standards for electronic health care transactions
- National identifiers for providers, plans and employers
- Security and privacy of health data
These standards help increase efficiency and effectiveness of the United State’s health care system.
- The Fair Debt Collection Act
- This is regulations established by the FTC that governs how and when a debt may be collected. It does not cover debts incurred from running a business. FDCA is responsible for:
- Protecting us from strong arm tactics and threats
- Covering personal, family, and household debt (personal credit cards, auto loans, and medical bills)