HIPAA And Code Sets

Imagine this scenario: What if your medical billing claims were suddenly rejected at a rate of up to 25%. Sound like a nightmare? You bet it does,but it could happen to your practice if you don’t keep up with HIPAA regulations and current coding changes that occur many times per year. That is a huge chunk taken out of your reimbursement revenue, and could easily be avoided through proper filing of your medical billing claims.

On Oct. 16, 2003, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) took effect and with that a new set of standards for the transactions and code sets that you use every day to generate your medical billing changed overnight. After implementation of HIPAA, Medicare would no longer accept paper claims from any practice that has 10 or more full-time staff. This resulted in a huge change for the medical billing industry and a rush to update standards in coding to make sure all reimbursements were handled.

This would be a good time to consider outsourcing your medical billing. Your medical billing partner will handle your claims, make sure HIPAA standards are met and in many cases exceeded, and track your reimbursements. Statistics show that practices who file their own claims can suffer up to nearly one quarter of their profits lost due to incorrect coding, lack of documentation, and other errors that cause delays and denials in their medical billing reimbursements. Additionally,if you’re missing billing for one single service per day, you’re costing your practice about $15,000 per year in lost revenue on the average.

Another bonus for outsourcing your medical billing is that your medical billing partner will handle tracking of your reimbursements and A/R to free up your staff to do what they do best, help run your growing and thriving practice.

View all Articles by: Melissa Clark, CCS-P