The Medical Billing Process, Essay Example

How HIPPA Violations Affect the Medical Billing Process Part Two

The CSM 1500 billing process is a claim form where a patients personal information is provided on the top portion including their name, social security number, type of insurance carrier, insurance number, employer, address, phone number, authorized signature, room for authorization and insurance authorization or prior authorization number, doctor information such as diagnosis, date of service, charges, diagnosis, physician’s signature, etc. Accompanied with this form is a person’s Privacy Rights.

999Social, legal and ethical ramifications of HIPPA violations can have a huge impact on the medical field as well as the price people have to pay for the medical services according to Face book research (2009). “Consider nurses and doctors who share workplace information on social networking sites which are in violation of patients’ rights”. (“Misuse of Social Networking May Have Ethical Implications for Nurses”). Consider the nurse who wrote about a patient’s gun rights on the social network Twitter who also violated his civil rights and rights to privacy. These rights are all protected under HIPAA and nurses, doctors and other medical professionals are all trained in the rights and responsibilities that accompany this act.

HIPAA, ICD, CPT, HCPCS all influence the top ten medical processes by keeping a close tab on the requirements that doctors must follow along with the requirements hospitals must comply with in order to meet certain standards to satisfy claims for patients. These agencies are in place under authority of the federal government instated under acts and legislation by authority of the United States government. The hopes are to crack down on medical fraud and hold doctors and hospitals accountable for medical procedures, surgeries and other acts that are not deemed necessary as per American Medical Review Boards.

Diagnosis: HIV and Aids from the perspective of HIPAA

HIPAA must fully comply with the rights and privileges of each patient according to the Medical Privacy Act to keep all patient records private and confidential unless the said patient authorizes the release of his/her records to the doctor/physician(s) or any other person by signature and date. Without such authorization by the patient the entire medical record is sealed and totally confidential. If a doctor or his representatives improperly discloses a patient’s medical records there are legal grounds for a lawsuit under the Privacy Act for infringement of a person’s privacy rights. HIV/Aids information is more sensitive than other medical information because the disease is already attached with a ‘stigma’ because everyone is not fully aware of the dangers of the disease. There has been numerous employment discrimination suits filed in the United States based on the allegations of those infected with the disease because people knew little to nothing of how the disease was contracted or transferred. This information must be protected to preserve a patient’s reputation and dignity. With the transference of improper disclosure relating to a disease, socially a person could be branded with a bad reputation, could be legally held for defamation of character and could be ethically sued for lack of proper professional standards whilst handling their job.

Prior to the passage of the Medical Privacy Act and HIPAA patients only had rights under the United States Constitution which were very general with no specific rights to privacy with relation to how their records should be treated in relation to sharing of their most precious valuables such as diagnosis and surgeries. It has been seen through various legal channels and litigations that often a person has been overlooked for a position because of their medical diagnosis such as heart disease or even HIV/Aids. Though this is not constitutional there had been little legal channels to enforce such infringement of such rights prior to HIPAA. HIPAA established the laws and definitive rights of any person to keep private any and all information from their spouse, children, employer, other doctor, nurse, etc. It is through this enactment that a person can consult a medical professional for their health and feel their privacy rights will remain private for sure.

Sample Hipaa Insurance Information Sheet (Csm 1500)

A patient should never fear the rights of their privacy according to our U.S. Constitution as afforded by our founding fathers. The HIPAA give a little more protection. The stronger the diagnosis the more protection afforded the patient. If a stigma is attached to the diagnosis the provisions of the Act will take every safeguard to ensure the rights of the person affected is protected for social, legal and ethical reason so that their rights are not infringed.

Medical billing and coding are affected based on the HIPAA codes because of the strict adherence to social, ethical and legal standards placed on making sure all ‘I’s are dotted and all ‘T’s are crossed. This is simply a mandate by the federal government because of the high premiums put forth by the insurance companies. The insurance companies charge high premiums because of the high dollars charged by the doctors. The doctors charge high prices because of the high insurance they must indemnify in case they are sued by patients. Let’s keep in mind though it is very difficult for a person to win a tort law suit against a doctor for malpractice because a doctor has only to prove that he or she acted ‘as a skillful doctor would have acted’ and not necessarily as a prudent person would have liked the doctor to do. Doctor’s are human and people often forget that. The Hippocratic Oath does not make a doctor in humane.

Conclusion

It is apparent the government has to put tight mandates on the medical professional including on billing so that the doctors do not take advantage of the insurance companies. HIPAA is one of the many Acts that have afforded authority and a means to track the records of billing and accountability of doctors and insurance companies in the medical profession. The patient’s have rights, also and these rights should also be protected. HIPAA and other authorities working together mandate protection for the citizens.

References

Privacy Rights for the Medical Patients Retrieved May 21, 2010 from, http://www.infringementofrightsnomore.com

Weome, K. (2009) HIPAA for You Retrieved May 21, 2010 from, http://basicmedical.gov.

HIPAA (2010) Unsure How to Handle HIPAA Retrieved May 23, 2010 from, http://www.hipaa.org/