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Medical Billing Process

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The privacy of patients remains as one of the most important ethical practice among members who are mandated with the task of delivering medical services to people in the society. Following this point, there has been debate among the policymakers on different ways that could be employed in ensuring that medical information that pertains to patients is secure. Apart from ensuring that this information is secure, there is also a need to guarantee that the doctor-patient relationship will not in any way violate the privacy standards that have been set. Instead, it is required that this relationship will uphold these privacy standards, whether the patient-doctor relationship is verbal or non-verbal, i.e. written. In line with this, there are different patients’ diseases that need utmost privacy standards to be maintained in the society.

One of the diseases in the society that required enhanced privacy measures is HIV and AIDS. In reference to Roach & American Health Information Management Association (2006), the treatment of records that belongs to patients who have acquired immune deficiency syndrome (AIDS) or are human immunodeficiency virus (HIV)-positive is a significant problem in the medical records management (p.344). There are many issues that surround the recording and storing of information that belongs to such kind of patients in the society. With this in mind, there are different policies that have been developed by the government to ensure that such privacy or rather the protection of information that belongs to such kind of patients is acquired and maintained in the medical world.

The formulation and enactment of the Health Insurance Portability Accountability Act, HIPAA, is one of the greatest milestones in achieving the required privacy in regard to HIV and AIDS patient information. This act has ensured that information that belongs to patients is well protected. On the other hand, there is an enhanced medical billing process since maintenance of these records is cheaper as compared to older systems. In addition to this, efficiency in the process of filing and retrieval of employee information is increased substantially (Roach & American Health Information Management Association, 2006).

Before delving into how HIPAA violations affects the medical billing process especially in regard to HIV and AIDS, it is important to examine why HIV and AIDS information is more sensitive than other types of health conditions. To begin with, the mode of transmission of HIV and AIDS is by a big percentage through sexual intercourse (Fan, Conner & Villarreal, 2010, p.191). Notably, reproductive health has continued to be a silent issue in many societies across the globe. This is because sex and sexual matters are considered as a taboo in the societies and therefore sexual matters cannot in any way be discussed openly. This stigma on sexual matters has created a stereotype in the way HIV and AIDS health conditions are perceived in the society. In essence, any person that has been diagnosed with this condition would ultimately receive automatic rejection from the society since it is believed that such a person is promiscuous. Therefore, this has made HIV and AIDS information to remain as the most sensitive information in the medical field.

The association of HIV and AIDS with immorality has also contributed to the need for high level privacy on information regarding this health condition. Most people are unaware of the fact that HIV and AIDS have other transmission modes such as sharing needles and other piercing equipments as well as through any form of blood transfusion. Instead, a good percentage of the society believes that all people who have HIV and AIDS got it through sexual contact (Fan, Conner & Villarreal, 2010, p.191). However, this is not the case always since there are other modes of transmission. Therefore, the medical world has no choice but to ensure that information regarding patients with this condition is kept in privacy as much as possible to protect them from character defamation that emanates from the general society that believes that HIV and AIDS is transmitted only through sexual contact.

The perception that there is no cure for HIV and AIDS has also contributed positively towards categorizing information in regard to this health condition in the society as the most sensitive information than that of any other health condition. In conjunction with this, most people in the society believe that when one contracts HIV and AIDS, that person is on his way to the grave (Fan, Conner & Villarreal, 2010). Therefore, such people are discriminated in the society due to their condition and in most cases, they have been found to die not from the condition they have but from stress due to rejection by the society.

It is also important to look at the social, legal, and ethical ramifications of improper information disclosure. There are many consequences that are associated with improper disclosure of personal information to any entity whatsoever, either individual or group regarding the health status of a particular person. As mentioned earlier, a person will feel socially degraded when certain conditions of his or her life are brought into the limelight. Whether such person is discriminated by the society or not, he or she will feel a sense of betrayal in his life that in most cases lead to internal death, i.e. having psychological and emotional challenges that affect negatively the health condition of a person (Roach & American Health Information Management Association, 2006).

Apart from the social dimensions, the legal world too has important laws and regulations in regard to sharing of personal information especially in regard to their health status (Roach & American Health Information Management Association, 2006, p.33). In this regard, one would be risking prosecution when he or she discloses a person’s health information especially where HIV and AIDS condition is involved. If one complained that his or her health information had been shared out without personal consent, the person in question risked being prosecuted. This is because the law recognizes the important of information privacy. Apart from the fact that was in danger of being prosecuted, it is also unethical to share out another person’s information in regard to his or her health without this person’s consent. In fact, the ethics for medical practitioners requires that privacy between the medical practitioner and the client is maintained.

HIPAA violations have been found to affect the medical billing process. In this regard, there are different health care organizations that have often opted to bypass the regulations that are stipulated in the HIPAA Act as a way of dealing with healthcare care issues that involves clients’ privacy. However, it is important to note that such violations calls for a sever punishment from HIPAA and affect the medical billing process. Remarkably, violation of HIPAA standards has been found to affect the cost of healthcare to the organizations that are involved (Durgin & Hanan, 2004). This emanates from the fact that such violations increase the costs of operation of these health care organizations that have to stick on older systems. It also warrants for a fine that is determined by HIPAA ranging from $100 to $500 per violation. More importantly is the fact that violation of HIPAA regulation might lead to disconnection of a health care organization from the HIPAA system, thus reducing or totally grounding the medical billing process activities of this organization.

It is important to understand that the standardization of the billing process that is pursued by HIPAA is meant to be embraced by every organization that is involved in health care services. Therefore, when an organization fails to comply, this organization creates an opportunity for it to be locked out of the HIPAA system leading to a loss of business and damage to important business relationships. In addition to this, there are high costs that are involved in the maintenance of old systems. This has been found to decrease efficiency in such organization thus lengthening the overall medical billing process (Durgin & Hanan, 2004, p.92).

The new system that has been proposed by HIPAA has been found to reduce filing and retrieving of patients’ information. In line with this, the old system would affect the billing process since it does not enjoy the benefits that are found in the HIPAA-centric model system. In addition to costs, HIPAA violations means that the health care organization that is involved will forfeit the benefits that emanates from the fact that HIPAA system is more efficient in terms of sharing of information with insurance providers (Durgin & Hanan, 2004, p.92). Similarly, non-complaint organizations have no enhanced security due to lack of electronic audit tracking and there is often problems with tracking of files and documents that belongs to clients to bulky paperwork. These components of the HIPAA system have been found to increase efficiency during the medical billing process. Therefore, failure to adhere to this system’s requirements would as well be creating a room for lengthy, expensive and inefficient medical billing processes.

The adoption of HIPAA regulations in the cases of HIV and AIDS patients has been found to increase the privacy of their information. However, health care organizations that fail to adopt these regulations and implement the HIPAA system as a way of managing patient record would increase the susceptibility of HIV and AIDS patients to misuse or rather disclosure of their personal information to unreliable sources. On the other hand, lack of HIPAA systems would increase length of the medical process and lead to poor medication of these patients in the long run. 

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