Archive for July 2010
Civil law is a set of rules where the penalty is monetary rather then jail time. If you violate civil laws, the person’s whose rights you violated, can take you to court seeking monetary damage. An example from our last blog can be used here: Mr. Roberts rights were violated when the medical insurance specialist told people in the waiting room that Mr. Roberts was an alcoholic. Mr. Roberts can file civil charges in court seeking damages from the medical insurance specialist, the healthcare provider, and the healthcare facility that violated his rights. The medical insurance specialist, the healthcare provider, and the healthcare facility defend themselves against the charges brought by Mr. Roberts by going to court and challenging Mr. Roberts evidence and providing their own evidence proving that Mr. Roberts rights were not violated or at least not violated by the medical insurance specialist, the healthcare provider, and the healthcare facility. Mr. Roberts would be the plaintiff in this case and the health care facility would be the defendants. The Plaintiff and the defendants go to court and present their case to the judge and the jury. The jury listens to both sides and determines the facts. The jury is said to be the judge of the facts. The judge also listens to both sides and interprets the law the plaintiff, Mr. Roberts, claims were violated. The judge is there to be the judge of the law. Suppose Mr. Roberts claims that the defendants damaged his character, which is saying something that isn’t true that hurts his reputation. He presents evidence, such as a witness from the office, to support his claim. The judge defines the facts that must be proven to support a charge of defamation of character for the jury based on the law. The jury decides if the evidence that Mr. Roberts presented is legitimate and whether the facts presented support the claims Mr. Roberts is seeking. If the jury decides in Mr. Roberts favor, then the defendants are guilty. However, no one goes to jail. Instead, the jury or the judge decides how much money should be awarded to Mr. Roberts, and which defendants are responsible for how much $$$.
Civil law is the most common type of lawsuit in the Allied Health Industry. Each day brings new administrative laws and case studies that may change the guidelines and laws. That is, yeaterday you might be permitted to look at all the information about a patient a tomorrow you may only be allowed to view a portion of that information. Threfore, it is important to review and adhere to the latest guidelines used by your healthcare facility. Following these guidelines lessens the chances that you and the healthcare facility will become involved in legal action.
As a medical billing and coding specialist, it is important to be familiar the laws that may affect you. First of all, a law is a rule that everyone must abide by. There are four classifications of law that you should know; statutory law, administrative law, common law, and case law.
Statutory Law: Statutory law is a rule that is created by the legislative process. On the federal level, this is when the Senate, the House of Representatives, and the President of the United States agree on a rule. A similar process occurs on state and local levels.
Administrative Law: Administrative law is a rule enacted by a government official or a group of government officials in order to administer a statutory law. An example of this would be Medicare and Medicaid were created by statutory law. Authority was granted for the administrative branch of government to appoint officials to run these programs and create regulations. These regulations are the administrative laws we refer to above.
Common law – Common law is a rule that comes about from common practice rather than a rule created by a governing body or by a government official. You may have heard the term used, “common law” marriage. This is when after a couple have lived together and shared assets for a given amount of time, they are considered married. This is an example of common law.
Case law – Case law is a rule created by a court when interpreting statutory law and administrative law. Since the legislative process usually produces laws that are vague, and lots of times a prior case will be used to help explain what the intention of a law is.
When studying how to become a medical billing and coding specialist, you will learn more in depth about laws and the ones specific to your allied health field. Let this serve as an overview for the subjects which we will discuss more thoroughly in up and coming blogs.
16
Medical Billing and Coding: Ethics and Moral Values
0 Comments | Posted by admin in Uncategorized
Our standard of ethics stems from moral values that each of us forms based on conduct that our family, friends, neighbors, and religious and government leaders expect from us and what we expect from others. for many of us this means to treat every person the way we would want to be treated. Would you want a medical insurance or medical billing and coding specialist to tell others that you are an alcoholic? At first you may say that you’ll keep the patient’s information confidential, but in reality all of us have a tendency to gossip or share information. Gossiping doesn’t violate moral values because many of us have grown up in a culture where it is expected that some rules would be broken. In fact, we tend to look strangely who always obeys rules. You may have asked a police officer to give you a break and not write a traffic ticket , and it is not unusual to take a sick day even though you’re not sick. Does this violate moral values? The rule states that sick days are to be used when you’re sick. If you’re not sick, then you should take a vacation day or personal day, but not a sick day.
Medical billing and coding specialists, and insurance specialists and others in allied health fields follow rules created by the government, employers and professional associations. Government rules are laws and must be followed. Employers and professional associations create rules that should be followed. It is important for job security to know all the rules associated with the medical billing and coding profession. It is however, most important, to know the laws, because that can have legal ramifications if government laws breached and legal action can be taken.
Patients expect healthcare professionals to cure them, and when their expectations are not met, some patients take retribution by suing the healthcare provider and those who are involved in their care. Sometimes patients are not willing to take the necessary steps to care for themselves and want someone to blame. Medical billing and coding specialists and medical insurance specialists, along with the entire allied health field, can be targets for disappointed patients, and can also become victims of aggressive attorneys who seek out these disgruntled patients; sometimes patients who would not otherwise sue, are convinced by opportunistic attorneys that they can recoup their losses by bringing legal action against those who have provided them with healthcare.
Healthcare professionals are watched closely by various government agencies to ensure that all parties are treated fairly and legally. There have been laws and regulations created that outline procedures for prescribing medications, record keeping, proper billing methods to medicaid and medicare, and a host of other aspects of the healthcare industry. It is wise to be aware of the laws for medical billing and coding specialists, and medical insurance specialists so that they can be followed. Medical insurance specialists are exposed to increased potential for legal action because they handle confidential patient information and prepare the actual bills and related documentations submitted to government agencies for payment. However, in this day and age, no one is immune to legal action. As a medical billing and coding specialist or an insurance specialist, you can minimize exposure to a lawsuit by knowing the laws and regulations that govern the healthcare industry. A law is a rule that everyone must abide by. There are four basic classifications of laws in the allied health care industry. They will be defined and discussed in the next four blogs. They are common law, statutory law, administrative law, and case law.
Did you know that Mr. Gibbons, that little old white haired man that was here this morning, is an alcoholic? Who would have thought? The medical insurance specialist told this to the recetptionist as they walked through the waiting room on their way out the door at the end of the day. Just by chance, a neighbor of Mr. Gibbons was just finishing up her visit and happened to still be in the lobby. She had even chatted with Mr. Gibbons earlier that day as she watered her flowers and he walked his dog. She didn’t know Mr. Gibbons was an alcoholic until she overheard the gossip of the receptionist and the medical insurance/billing and coding specialist. In this case we discover what may appear to be innocent gossip can have far reaching implications for the medical billing and coding specialist and her employer because conversations regarding patients are likey to reveal confidential medical information. This is in violation of mediacl ethics and the law.
After Mr Gibbons learned that his medical condition was told to everyone in the waiting room, he consulted an attorney who brought charges against the medical insurance specialist, the healthcare provider, and the healthcare facility. Medical billing and insurance specialists work with patients and their records. These records must remain confidential. This is in adherence to ethical and legal standards common to the medical profession. Just think. How would you feel if you had private information shared about you? It was a coincidence that Mr. Gibbons neighbor overheard these girls talking….but you should always think twice about gossiping and spreading information about others.
If you plan to become a medical billing and coding specialist, it is necessary to understand insurance companies and how they work. That is why I have been harping on this information for the past week or so. I decided it might be helpful to sum things up today, cause I am tiring of the topic (as I am sure you are too.) Basically, the patient primarily pays for healthcare in the United States through the medical insurer rather then directly. This is where medical billing and coding meets insurance agency. Medical insurers usually negotiate fees with health care providers in order to control the cost of medical expenses. There are two types of health care providers: for profit, and not for profit. For profit healthcare providers operate as a business who’s goal is to make money, while non-profit healthcare providers operate as more of a service that usually requires financial funding from charity events, donors, and the government. Today’s healthcare system has evolved from a time when patients purchased insurance to cover loss of wages, rather then paying medical bills. The healthcare system continues to evolve today. When the United States moved from mainly farming communities to a more urban setting more people lived closer together. Because of the closer proximity to one another, this caused the spread of illness and an increased need for medical care. Blue Cross was the first medical insurance company to attempt at meeting this need. It began by just covering stays in the hospital. Blue shield was formed shortly there after to provide insurance coverage for when you visited a physician. Medicare and medicaid are government medical insurances that were formed in the sixties to help the elderly. They were having problems getting insurance at a reasonable rate due to pre-existing conditions. Medicare and Medicaid attempted to help those who could not afford other forms of medical insurance. It will be interesting to see how our new health care reform will affect the allied health industry. Is social reform the answer? Things continue to evolve.
Three-quarters of the United States were covered by health insurance in 1958. At this time, the U.S. had managed to develop a privately operated and funded health inusrance program that was favorable to healthcare providers, subscribers, and employers. However, there was a problem with private health insurance, just like we are experiencing problems now that call for reform; The problem then was that only workers and their families were covered. The unemployed could purchase a health insurance policy themseleves (independently), but most could not afford the high premiums the private health insurance companies were demanding. Many of these people happened to be elderly and sick, which in turn would increase their risk of further sickness. Since medical insurance companies priced premiums based on an analysis of past medical reimbursements, those who were at a higher risk of becoming sick would incur higher medical expenses. Therefore, these elderly patients were being charged higher prices than workers. The solution became national health insurance. Government leaders realized there was a large opposition to the idea of national health insurance, so rather than fight a battle that had been lost many times, government leaders proposed government sponsored health insurance that provided medical coverage to the elderly. This qualified anyone above the age of 65. Most opponents agreed with the plan, except The American Medical Association. They feared that government sponsored health insurance would enable patients to take advantage of unnecessary medical services and therefore overload the medical system. Government leaders acknowledged this could be a potential problem, so they limited the government sponsored health insurance to hospitals. In 1965, Congress passed the Social Security Act, which created Medicare and Medicaid.
