WHAT IS HIPAA?
- Health Insurance Portability and Accountability Act of 1996
- Is United States legislation that provides data privacy and security provisions for safeguarding medical information
- The HIPAA legislation has four primary objectives: Assure health insurance portability by eliminating job-lock due to existing medical conditions. Reduce health care fraud and abuse. Enforce standards for health information.
- Sets the standard for protecting sensitive patient data.
WHAT IS MEDICAL CODING?
- Is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers.
- Classification of Medical coding in Billing such as ICD-10, CPT and HCPCS.
WHAT IS ICD, CPT AND HCPCS?
- ICD – means international classification of Diseases revision 10 (ex. R32.0 – urinary incontinence unspecified)
- CPT – means Current Procedure Terminology. (Ex. 99211 – office visit 15 minutes)
- HCPCS – is a set of health care procedure codes based on the American Medical Association’s Current Procedural Terminology.
(ex.T4541 – diapers)
FORMS USED IN MEDICAL BILLING
- CMS-1500 – is a form issued by the Centers for Medicare and Medicaid Services and used by Health Care Professionals to request reimbursement for services provided to patients. This form is used for reimbursement from various government insurance plans including Medicare, Medicaid and Tricare. (Professional Claim)
- UB-04 – also known as CMS 1450 form. And a standard billing claim form used for medical claims. (Facility Claims)