HIPAA plans and the effectiveness of the

HIPAA and Medical Billing




Tetyana Usenko







HIPAA and Medical Billing

(The Health Insurance Portability and accountability act of 1996) is a legislation
proclaimed on August 3, 1996, which primary goal was to “remove the health
condition from health insurance considerations” to upgrade and refine
portability and continuity of the amount of protection given by health
insurance and combat misuse, fraud, and abuse in health insurance and
healthcare distribution.

The legislation was split
up into seven titles:

Title I – Health care access, portability,
and renewability.

Title II – Stop Health care fraud and
misuse, administrative simplification, and medical liability reform

Title III – Tax-related health provisions

Title IV – Group health plan requirements
application and enforcement.

ensures the protection scope of laborers after they lose or change their
activity, it secures the protection of patients’ therapeutic data, builds up
principles for electronic therapeutic exchanges, and sets up the disciplines
for fake therapeutic revealing practices.

institutionalized medicinal codes and set up the Electronic Data Interchange
frame that we utilize to send asserts electronically; this EDI has various
writings, each of which compares to a specific type of exchange between a
supplier and a payer.

act states that the motivation of Title II, Administrative Simplification, is to
advance the Medicare and Medicaid plans and the effectiveness of the health
care system by supporting the development of a health information system via
the establishment of standards and requirements for the electronic transmission
of certain health information.



Billing is the operation of procuring payments for services that healthcare
providers give to patients. The majority of the US population have some form of
health insurance that will pay, to a certain extent, part of the medical bill.
The healthcare provider submits the invoice to the insurance institution for
payment. Most medical bills, nowadays, are sent electronically, in which case,
the provider sends the needed information in a pre-defined format that the
insurance institution requires. When the insurance company receives a claim, it
can either deny it, settle it or retain it for further information.


important entity in the medical billing business is the medical coder, who
audits the patient’s records to summarize and codify the services that the
doctors supply to patients to make sure that they send accurate codes to
insurance institutions and that they properly process the claims. Coding
conveys the entire billing process.






and Medical Billing (2018, January). Retrieved from http://www.medicalbillingandcoding.org/section-3-review/

Medical Billing (2018,
January). Retrieved from https://en.wikipedia.org/wiki/Medical_billing






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