The health care industry has changed significantly over the years. Physicians used to make house calls and accept payment in trade. Today's modern world has made health care and insurance a billion dollar industry. As a result, there have been many changes over time as to the requirements that providers must meet to be paid for their services.

History of Physician Billing

Physicians collected fees for services from patients until insurance companies became involved and started paying the physician's "usual and customary" charges for their covered buyers. When the government became involved, fees began to be set rather than based on "usual and customary" and more requirements were placed the submission of claim forms.

HIPAA Rules

The Health Insurance Portability and Accountability Act (HIPAA) sets the guidelines for medical billing. All practices, no matter how large or small they are must comply with HIPAPA's security, transaction and privacy regulations. In 1996 HIPAA was proposed by Congress to help to standardize the insurance billing industry.

Claim Form Requirements

There are literally more than 100 pieces of information that must be obtained and transmitted to an insurance company to be paid. If even one piece of the information is inaccurate, it may result in the rejection of the claim.

Coding Requirements

Services have to be reported using Current Procedure Terminology (CPT), and the diagnosis or complaint is reported using International Classification of Diseases (ICD-9) codes. The World Health Organization (WHO) is the organization that establishes the CPT and ICD-9 coding methodologies.

Technology And Claim Submission

Medicare along with others insurance companies only accept claims filed electronically. Paper Health Care Financing Administration (HCFA) claim submissions will be rejected.

Source:

Medical Billing Software List

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