What You Need to Know About HIPAA Compliant Coding

HIPAA Compliant CodingMedical coding is no ordinary business. In the U.S. healthcare landscape, data privacy and security rules the roost and coders are considered to be the strongest pillars. While shuffling through the sensitive information, medical coding specialists should have the expertise on Health Insurance Portability and Accountability Act (HIPAA) regulations and overlooking the same, could lead to federal investigation.

The ultimate forte is to secure insurance information and its data— include patients and providers— Medical coding experts are accountable for the electronic and physical swapping of such sensitive information amid different parties. To curb the explosion of intricacy in medical practices and its administrative chores, HIPAA was born as a savior.

HIPAA has explicit security coverage of any medical information—that a doctor, nurse or therapist places in a patient’s file—including billing information, history, and diagnostic notes, and even exchange of dialogues between medical specialists about the patient.

The stringent medical coding guidelines have been set forth by HIPAA and the Office of the Inspector General (OIG). Being a coder, it is mandatory to act in accordance with HIPAA. If any patient observes that, their privacy rights are violated, can file a complaint through the U.S. Department of Health and Human Services (HHS).

It entails:

  In HIPAA coding, you need to know the unique identification codes for medical procedures
  A methodical awareness of tech safeguards for privacy, electronic signature rules and more are required
  HIPAA is divided into five titles, with Titles I and II being the principal and most comprehensive

To go across the board, let’s take a brief glance on Title I and Title II of HIPAA

Title I gives health insurance coverage for employees and dependents by making healthcare plans available to those who have lost their job or are in the process of switching employers.
Title I also restricts the amount of time it takes to get coverage for someone who has a pre-existing medical condition. Once a person has coverage under a group health plan, that person must receive healthcare coverage for their pre-existing condition within 12 months.
Title II of HIPAA addresses many of the disquiets pertinent to the medical coding field. This segment deals with security and privacy requirements for managing patient medical records, as well as design to abridge billing and processing of claims.
How providers and insurance companies should avoid healthcare counterfeit is also outlined by Title II of HIPAA.
To expand, HIPAA has extended its security and privacy procedures into two segments. They are Privacy Rule and Security Rule.
Medical coding professionals must not share a patient’s private health information with parties that aren’t considered covered entities. Illicit entities can include providers and insurance companies.
When HIPAA was passed, it added an “Administrative Simplification” that established regulations for the electronic transmission of healthcare data. This section, in turn, established a uniform method of communication for any party involved in healthcare, such as insurance payers, providers, and government agencies.

In a nutshell, HIPAA regulation restricts—who can view medical information and how— this information is transferred. The regulations established its foothold, who can distribute patient medical information and when they can be shared.


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