Reimbursement and Billing Compliance.

Health care professionals and businesses rely on billing and reimbursement practices to succeed. Compliance with federal and state laws and regulations, however, can be difficult. A health care entity can improve compliance by developing and implementing effective billing and reimbursement programs that adhere to industry and governmental standards. The professionals at G2Z Law Group, PLLC will work with your health care professionals to ensure that all they follow all relevant reimbursement and billing laws and regulations.

What kind of reimbursement and billing issues should my business be prepared to address?

The Centers for Medicare and Medicaid (CMS) provides many regulations related to health care transactions, which it defines as “electronic exchange[s] of information between two parties to carry out financial or administrative activities related to health care.” CMS provides oversight of government-subsidized medical plans including Medicare and Medicaid. It provides specifications for health care claims, payment transactions, claim status requests and notifications, eligibility/coverage/benefit inquiries, and health care service review, among others. Some transactions are required to abide by standardized operating rules.

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that significantly impacted medical billing. HIPAA requires particular privacy standards when “covered entities” and “business associates” use private health information. The most pervasive HIPAA concern is patient confidentiality. Health care businesses are required to create safeguards against privacy violations in all areas of communication, including billing and reimbursement practices. These safeguards include requiring every medical office employee to acknowledge and promise to adhere to confidentiality practices. HIPAA also requires that every patient be informed of their privacy rights and provide signed waivers for any exceptions.

One of the more recent changes in HIPAA legislation was an emphasis on electronic patient data privacy. Medical billing companies are required to implement confidentiality rules into their operating procedures. HIPAA requires that some transactions—known as standard transactions—must be completed electronically. Claims are included as standard transactions.

State laws, such as state medical assistance, insurance, privacy or fraud laws, may also apply to billing for medical services. Healthcare entities must ensure that their internal billing or billing contractors follow the proper federal and state standards in coding and billing claims for you or your practice.

What happens if my health care business violates reimbursement and billing compliance laws?

Failing to adhere to reimbursement and billing laws is a serious issue. Knowingly doing so is known as medical billing fraud, which can be punishable by fines or jail time. Changes in health care policy have increased pressure on federal agencies to crack down on fraud and abuse. The number of regulations that apply to health care businesses can be overwhelming, but keeping track of billing and reimbursement rules is easier with the help of G2Z Law Group.

What can G2Z Law Group do for my health care business?

Complying with HIPPA and the CMS rules are just two areas of concern for your health care business. The legal team at G2Z Law Group is here to guide you through these regulations as well as those of other federal and state agencies. Our firm will give you the legal guidance to remain in compliance with billing and reimbursement issues.