Medical Billing Policy And Procedure Manual
The policies and procedures for a medical office or clinic are crucial to laying out the health care and administrative standards that clinicians are expected to meet. A policy and procedure manual tells doctors, nurses and other office staff how to perform certain duties so that they can provide quality care to patients.
The policy and procedure manual is essential to the efficient operation of every medical practice. Its purpose is multifold: to serve as a.
Since the health care industry is complex and is managed by numerous regulations, a policy and procedure manual also dictates which laws must be adhered to. Writing medical policies and procedures is an ongoing practice, as the changing laws in healthcare often mandate that your medical office's policies change, too. Make a list of the categories or sections that you want to have in your policy and procedure manual. Examples of categories typically found in medical policy and procedure books include, but are not limited to, Insurance, Medical Filing, Claims Submission and Billing, Patient Safety, Employee Safety, Credentialing and Privileging, Pharmacology, Client Rights, Confidentiality and Employee Training. Identify the legal requirements - or licensing requirements - that pertain to your line of medical work. For instance, if you are writing policies and procedures for a cardiology office, your clinic may have a specific set of regulations to follow that are different than the ones a pathology office needs to adhere to. In order to write effective policies and procedures, your policies must be in line with the federal regulations.
Create a template for your policies and procedures. Templates will help you keep each policy you draft consistent and standardized. The template should include the title or number of the policy, the purpose of the policy, applicability and the steps of the procedures that must be carried out.
You might also include an addendum notice if the policy goes hand in hand with a particular medical form. For instance, if you are writing a policy and procedure for 'patient intake,' you would attach the patient intake form to the end of the policy. Use your main policy categories to come up with individual policies.
If your main policy category is Confidentiality, you might have two separate policies within that section, such as Electronic Security and Patient Health Information Disclosures. Under your Medical Filing category you might have policies for Timely Filing and Medical Records Requests. Begin writing the procedures for each policy you want to include in your book.
Write them directly into the templates and label them draft for now. Be as specific as you can for each policy you write.
All steps should be clearly outlined and easy to understand. Create a table of contents for your medical policy and procedure book.
A table of contents helps keep things organized so that readers can find the policy and procedure they are looking for with ease. Make sure your policies are HIPAA compliant. HIPAA, the Health Insurance Portability and Accountability Act, is a federal regulation that makes it illegal for health care entities to release patient health information without the patient's consent. Failure to follow HIPAA standards can result in your organization being fined for noncompliance, and can lead to a law suit if a patient feels like their confidentiality was breached. Send your draft policies and procedures to the appropriate authority in your organization, such as the Medical Director or Chief Medical Officer, for review and final approval. Review your policies and procedures on an annual basis to make sure that you do not have to make any changes to them. Add new policies to your book as they come up, and delete old ones that no longer apply.
Medical billing policy procedure guide. 1. Policies and Procedures. MBA Medical Billing Services, Inc Policy and Procedure Guide Page 2 of 45 Table of Contents STANDARDS OF CONDUCT. 3 CONFIDENTIALITY. 5 ACCESS TO PATIENT INFORMATION.
6 WORKSTATIONS. 7 CLAIM GENERATION PROCESS. 8 WAIVERS, DISCOUNTS AND FINANCIAL HARDSHIPS. 9 STANDARD ADJUSTMENTS. 11 BANKRUPTCY. 13 MAIL RETURN ACCOUNTS. 13 BAD DEBT AND COLLECTIONS.
14 IDENTIFYING AND REPORTING CREDIT BALANCES. 15 PATIENT RIGHTS. 16 PATIENT ACCESS TO HEALTH INFORMATION. 17 PATIENT AMENDMENT TO HEALTH INFORMATION. 17 USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION. 18 DE-IDENTIFICATION OF PROTECTED HEALTH INFORMATION. Instructor solution manual for linear algebra with.
19 MINIMUM NECESSARY INFORMATION. 21 HANDLING OF PRIVACY COMPLAINTS. 23 ASSESSING RISK AREAS FOR FRAUD, WASTE AND ABUSE. 25 ROLE AS A CLEARINGHOUSE. 26 ROLE AS A BUSINESS ASSOCIATE.
27 SECOND TIER BUSINESS ASSOCIATES. 28 DEVELOPING PROPOSALS AND SERVICE AGREEMENTS.
29 SERVICES, RESPONSIBILITIES AND FEES. 30 INTERRUPTION OF CLIENT SERVICE.
35 PHYSICAL SECURITY. 37 SYSTEM MAINTENANCE & CONTROL LOGS. 39 CONTINGENCY PLAN. 40 DISASTER RECOVERY PLAN. 43 Revised 5/19/06. MBA Medical Billing Services, Inc Policy and Procedure Guide Page 3 of 45 Standards of Conduct Mission, Goals and Ethical Principles MBA Medical Billing strives to maintain the highest ethical standards in the industry of professional medical billing. We endorse the compliance efforts of the OIG and have established an internal compliance program that employees readily understand.
Our standards of conduct reflect our commitment to the highest quality health data submission as evidenced by our accuracy, reliability, timeliness and validity. The Compliance Manager works with the management to write and adopt standards; respond appropriately to complaints and other information concerning illegal or unethical activity (suspected or known); investigate promptly all such complaints and information and take appropriate corrective action; ensure that all staff and independent contractors/agents have been checked against the Office of Inspector General’s List of Excluded Individuals and Entities; and report to management on compliance program progress.
The management team will identify risk areas; write policies and procedures; implement policies and procedures; monitor audits and investigations both internal and external; analyze and develop new strategies as needed; and periodically review compliance policies and procedures for adequacy. Purpose The Standards of Conduct of MBA Medical Billing Services, Inc ensure compliance with healthcare fraud and abuse laws. MBA is committed to complying with all state and federal mandates governing the operation of healthcare billing companies. Compliance with Laws and Regulations Accurate Claims Coding and Submission: MBA Medical Billing does not bill for services or items that have not been documented or supported by our client’s medical record or encounter form as forwarded directly from the provider’s office. Accurate Business Records and Retention: MBA Medical Billing’s business records are properly documented and reflect facts regarding all business transactions.
In accordance with OIG regulations, records are retained and safely secured in either paper or electronic forms for a period of seven years from the time of service. Revised 5/19/06. MBA Medical Billing Services, Inc Policy and Procedure Guide Page 4 of 45 Kickback Prohibition: MBA Medical Billing does not provide incentives to attract patients nor do we engage in any other activities that would violate OIG’s Anti-Kickback Statutes. Refund of Overpayments: If MBA Medical Billing determines that an overpayment has been made the credit balance will be submitted for refund to the proper party, regardless of whether a refund has been requested.
Courtesy Discounts and Waivers of Co-Payments: MBA Medical Billing does not waive or adjust co-payment or deductible obligations of patients, unless instructed to do so by our client, who we believe in good faith will uphold legal standards. Hardship, bad debt, and out-of-network adjustments are to be utilized only when the patient meets the documented requirements for the adjustment and will be used without discrimination. Honesty: MBA Medical Billing will follow ethical business operations and good common sense, promoting a ‘best practice’ approach. No MBA employee or subcontractor/agent will attempt to mislead government bodies or agencies to influence actions or decisions. Cooperation with Government Investigations: MBA Medical Billing Services, Inc will be cooperative and forthcoming in any government inquiries, including audits, questioning and reviews. Financial Interests: MBA Medical Billing’s administrators, employees and subcontractors/agents may not solicit or accept gratuities, favors or bribery that may influence sound and legal business decisions.
Confidential Information: All employees and subcontractors of MBA Medical Billing are required to sign applicable Confidentiality Agreements (employees) and Second Tier Business Associate Agreements (subcontractors/agents) to protect health information handled through business operations. These agreements will be in accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Additionally, confidential information about MBA Medical Billing is not to be communicated outside of the company by any employee without explicit written authorization of the administration.
Violations of Standards of Conduct Violations of MBA Medical Billing’s standards of conduct must be promptly reported to the Compliance Manager. If the Compliance Manager or another administrative member has violated the standards, another manager must be notified. Revised 5/19/06. MBA Medical Billing Services, Inc Policy and Procedure Guide Page 5 of 45 Confidentiality General Policy It is our policy that all internal business of MBA Medical Billing Services, Inc is confidential. Confidential information may not be communicated by any employee to the public. All documents and files generated in the course of duty as an employee are the property of our organization and considered business records.
Medical Office Billing Procedure Manual
All requests for disclosure of business records will be handled in accordance with our policies and procedures. Corrective action will be taken for all violations. Definitions Confidential Information: Any information, whether written or verbal, relating to the internal business operations of our organization not available to the public. This includes general business operations, finance records, fee schedules, marketing plans, contractual agreements, client information and billing records. Procedure Employees must adhere to the following standards at all times: Employees must never discuss information regarding a client or client’s patients (including medical and billing records) with anyone other than to carry out job duty functions on behalf of the client.
Discretion and responsibility are expected and should be exercised by all employees by not disclosing any organizational information about MBA Medical Billing Services, Inc. Revised 5/19/06. MBA Medical Billing Services, Inc Policy and Procedure Guide Page 6 of 45 Access to Patient Information General Policy Access to a patient’s billing record must be treated with utmost respect and confidentiality. Access to both paper and electronic medical records should be limited to only those employees for whom the information is necessary for the completion of job duties. Procedure It is the responsibility of the Systems Administrator to manage MBA’s computer systems, including all linkages to external systems, so that access to patient health information is not unduly obtained and to ensure compliance with the security standards documented herein. It is the responsibility of the Systems Administrator to regularly review the security controls of the billing systems to ensure that they are all functioning properly. It is the responsibility of the Systems Administrator to review all audit reports and note any suspicious activity.
Audit records shall be kept at least six months and custodians shall periodically review them for evidence of violations or system misuse. The Systems Administrator must periodically review user access privileges and remove identification codes and passwords from MBA’s computer systems when user’s no longer require access. Access to patient records may be obtained only by those employees who have been specifically authorized by the Compliance Manager.
Incidents or suspicions of unauthorized access to patient information should be recorded and reported to the Compliance Manager. Revised 5/19/06. MBA Medical Billing Services, Inc Policy and Procedure Guide Page 7 of 45 Workstations Rules Governing the Use of Workstations The use of MBA’s information systems or data for personal business or gain is strictly prohibited. Employees are prohibited from unauthorized browsing of patient, personnel, financial, or other records for the purpose of personal curiosity or with the intent of improperly disclosing the information contained in those records. Every employee will receive a unique username and password for accessing MBA’s computer systems.
Medical Billing Office Policy And Procedure Manual
Employees should use their own username and password when performing their regular job duties. Usernames and passwords should not be shared except under special circumstances approved by the Systems Administrator. Employees are prohibited from listing their username and password on their monitors, under their keyboards, or in any other obvious location. Employees should log out when they are not using the practice management system.
Workstations will require a password protected login anytime a workstation is idle for more than 15 minutes. Employees are prohibited from leaving their workstation unattended with confidential information displayed on the monitor.
Employees are prohibited from installing unauthorized or illegally-copied software on any workstations. Employees are prohibited from altering or removing any software or data on any of MBA’s computer systems, except in the course of performing authorized business functions.
Employees are prohibited from interfering with the operation of any of MBA’s computer systems or using an MBA workstation to disrupt any external computer system.