A medical insurance billing (MIB) specialist is one of the most trusted individuals in a practice. Clinicians trust billers with the personal information of their patients, to obtain the largest revenues to which they’re entitled and to do so in a manner that’s accurate and legal. Nitin Chhoda discusses why integrity is one of the greatest assets a medical billing staff must have and why it should never be compromised.
Certified MIBs are specialists in their field and must conform to accepted coding practices and standards.
They have a moral, ethical and legal responsibility to code each reimbursement claim accurately, and deal fairly with patients, providers and payers.
Medical billing people are legally accountable for maintaining compliance and confidentiality, even if encouraged by unscrupulous individuals to “bend” the rules.
Ignorance is Never an Excuse
Coding regulations and requirements for submitting claims can change quickly. The onus is on the medical billing staff to remain informed and current, whether it’s a coding change or the manner in which clearinghouses accept reimbursement claims.
Always Keep it Private
Many billers are required to sign a confidentiality agreement and it’s becoming standard procedure in many practices. Confidentiality is more than a suggestion. It’s the law as outlined by HIPAA.
IMPORTANT: Patient information is to be protected at all times and there are stiff criminal penalties for those guilty of violations by word or deed.
Mistakes Cannot be Avoided But Should Never Be a Habit
No one is perfect and mistakes will occasionally be made. If there’s doubt about data contained in any portion of the patient encounter, obtain clarification from the practitioner before coding. When a medical billing staff makes a mistake, they’re obligated to report it to the payer and correct it.
No to Fraudulent Billing
There are many ways in which medical billing may be considered fraud. Over billing or unbundling to obtain more money, and under billing to get claims approved quicker, hurts the financial well-being of the practice and is illegal.
Routinely forgiving patient balances or failing to collect co-pays may run the practice afoul of anti-kickback statutes.
Insurance carriers are always seeking ways to avoid paying claims. Double billing and claiming for unnecessary procedures are red flags for payers, who have the option of initiating an investigation into the clinic and its medical billing practices.
Maintaining complete documentation that supports each medical billing reimbursement is critical.
Being Compliant is a Must
Medical billing staff must work within the dictates of the National Correct Coding Initiative edits to provide ethical, accurate and honest cost accountings to which practitioners are entitled. 
To maintain compliance, MIBs are charged with providing documentation that supports a diagnosis or procedure, and to explain costs that exceed the expected norm.
Compliance also extends to the methods by which patient information and reimbursement claims are transmitted.
The Affordable Health Care Act has mandated that billers and any entity or facility that transmits a patient’s personal data must do so through electronic medical record (EMR) technology that provides the appropriate security and safeguards.
