How Do Patient Rights Affect Medical Coding And Billing?

by  Find-A-Code™
Jul 6th, 2023

As a professional medical coder or biller, you are familiar with things like CPT and ICD-10 diagnostic codes. You are familiar with NPI lookup and CMS rules for coding services and procedures provided to Medicare subscribers. You should also know about patient rights and how these affect your job.

In most cases, patient rights and medical coding/billing intersect at HIPAA compliance. If you know how HIPAA relates to your profession and your daily tasks, you should have very little trouble guaranteeing patient rights are respected. If you don't know much about HIPAA, it's time to change that.

Patient Rights and Medical Billing

Patient rights play a significant role in the medical billing process. They are designed to protect patients, ensure that they receive appropriate medical care without unnecessary hurdles or financial burden, and prevent unapproved dissemination of private information. Patient rights are an important aspect of coding and billing that require an appropriate level of attention. The extent to which patient rights are protected partially determines patient satisfaction.

A crucial factor in patient rights is informed consent. Healthcare providers must inform patients about the treatment options available to them. They must inform patients of the benefits, risks, and costs of each option. Patients must also be informed about any coverage limitations of their insurance policies along with anticipated out-of-pocket expenses.

Informed consent offers patients a clearer understanding of the cost of treatment. This allows them to make informed decisions about their healthcare, including whether to proceed with a particular treatment plan. Informed consent also helps healthcare providers avoid billing errors – like charging patients for services they ultimately did not render.

Protecting Patient Information

From a HIPAA perspective, medical coding/billing and patients’ rights intersect at the point of confidentiality. Patients have the right to keep their medical history and personal information private. In addition, healthcare providers are required by law to take adequate measures to safeguard the information.

Medical coders and billers collect and store sensitive patient data as a normal part of the job. Therefore, healthcare providers typically implement strict security policies intended to maintain compliance among billers and coders.

Providing Timely and Accurate Bills

Yet another thing to consider is the patient's right to timely and accurate medical billing. Patients rightly expect to receive timely and accurate bills, bills that clearly outline charges and payment options. Providers must ensure accurate, efficient, and transparent billing processes if they want satisfied patients.

Patients obviously have the right to dispute medical bills. So healthcare providers must have dispute resolution mechanisms in place to address patient complaints. Failing to resolve billing disputes can lead to a loss of patient satisfaction, or worse.

When it comes time to pay a bill, patients have the right to choose their preferred payment method – whether it be cash, credit card, or insurance coverage. Offering a variety of flexible payment options offers patients access to the care they need with fewer financial barriers.

It is a Matter of the Law

Patient rights in the medical billing arena are a matter of law. Simply put, providers must comply with all regulations governing medical billing practices, including HIPAA. They must also implement adequate internal controls to prevent fraudulent billing practices.

Maintaining patient rights influences medical coding and billing practices. It has to. Healthcare providers are obligated by law to protect patient rights. Doing so promotes patient satisfaction and improves a provider's financial viability. By implementing effective billing processes that comply with relevant laws and regulations, healthcare providers can alleviate patient anxiety, improve service quality, and maintain a positive reputation in their communities.