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Detailed guide to Iowa
Medical billing in Iowa is governed by various laws and regulations. Here are the detailed guidelines and laws:No Surprises Act
- Notice of Your Rights: Health plans and facilities must send consumers a notice of their rights under the No Surprises Act. This notice is similar to one created by the Centers for Medicare and Medicaid Services (CMS).
- Complaints: If you believe you have been wrongly billed by a provider or insurance company, you can contact the Iowa Insurance Division or the Department of Health and Human Services at 1-800-985-3059 for assistance with disputing the bill through the federal dispute resolution process.
Iowa Admin. Code r. 191-15.32
- Prompt Payment of Certain Health Claims: This rule requires insurers to either accept and pay or deny clean claims for healthcare benefits under a benefit certificate or policy issued by the insurer. It defines terms such as "clean claim," "circumstance requiring special treatment," and "properly completed billing instrument." Certain insurance products, like liability insurance, workers' compensation, and automobile insurance, are exempt from these provisions.
Dealing with Medical Debt
- Defending Against Medical Debt: If you are unable to resolve payment issues with hospitals or doctors, they may start collection efforts. You can check if you have any defenses against the debt, such as the bill being wrong, the bill being paid by insurance, or the statute of limitations having expired. Iowa Legal Aid can help you with these defenses.
- Iowa Legal Aid: This organization provides help to low-income Iowans dealing with medical debt. They can assist with disputing bills, negotiating payment plans, and exploring financial assistance programs. You can contact them at 800-532-1275 or apply online.
- County Hospital Free Care: Iowa law requires county hospitals to provide free medical care to individuals without financial resources or the ability to earn income. You can contact the hospital's business office for more information on their free care program.
Your Billing Rights and Protections
- Balance Billing Protections: Iowa law prohibits balance billing for certain emergency services. If you receive emergency services from an out-of-network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount. You are also protected from balance billing for services received at in-network facilities unless you give written consent.
- Iowa Clinic Billing Rights: The Iowa Clinic provides information on your billing rights and protections, including the prohibition on balance billing for emergency services and the requirement that out-of-network providers not balance bill you unless you give written consent.
Surprise Billing in Health Care
- The Protecting People from Surprise Medical Bills Act: This act prohibits surprise billing for certain emergency services and certain services at in-network hospitals or ambulatory surgical centers. It also provides protections against balance billing for emergency services and services received at in-network facilities.
These laws and regulations aim to protect consumers from surprise medical bills and ensure that they are not unfairly charged for healthcare services.
The Iowa Total Care Coding Reference Guide provides detailed information on medical coding for various conditions and diseases. Here are some of the key points and codes mentioned in the guide:Coding for Chronic Conditions
- Asthma: ICD-10-CM codes include J45.9 (Asthma, unspecified) and J45.0 (Asthma with acute exacerbation).
- Attention Deficit Hyperactivity Disorder (ADHD): ICD-10-CM codes include F90.2 (Attention Deficit Hyperactivity Disorder, predominantly inattentive type) and F90.0 (Attention Deficit Hyperactivity Disorder, predominantly hyperactive-impulsive type).
- Autism Spectrum Disorder: ICD-10-CM codes include F84.0 (Autistic disorder) and F84.5 (Other specified pervasive developmental disorders).
- Bipolar Disorder: ICD-10-CM codes include F31.0 (Bipolar disorder, current episode manic) and F31.1 (Bipolar disorder, current episode mixed).
- Cancer: ICD-10-CM codes include C00.0 (Malignant neoplasm of lip) and C50.9 (Malignant neoplasm of breast, unspecified).
- Congestive Heart Failure (CHF): ICD-10-CM codes include I50.9 (Chronic heart failure, unspecified) and I50.0 (Chronic heart failure with left ventricular dysfunction).
- Depression: ICD-10-CM codes include F32.0 (Depressive disorder, mild) and F32.1 (Depressive disorder, moderate).
- Diabetes: ICD-10-CM codes include E11.9 (Type 2 diabetes mellitus, unspecified) and E10.9 (Type 1 diabetes mellitus, unspecified).
- Obesity: ICD-10-CM codes include E66.9 (Obesity, unspecified) and E66.0 (Obesity, morbid).
- Prenatal and Postpartum Care: ICD-10-CM codes include O00.0 (Pregnancy, unspecified) and O90.0 (Postpartum care, unspecified).
Coding Tips
- Use the highest number of available digits: Always code diagnoses using the highest number of available digits. For example, do not assign a 3-digit code if a 4-digit code is available for use.
- Code all documented conditions: Code all documented conditions that coexist during the time of the visit and that affect the treatment of the member.
- Use "With" and "History of" clarifications: Use "With" and "History of" clarifications as needed to accurately code conditions.
Additional Tips
- Ensure diagnoses are coded using applicable ICD-10 codes: Ensure diagnoses are coded using applicable ICD-10 codes to address medical conditions.
- Code to the highest specificity when applicable: Code to the highest specificity when applicable, using correct CPT/HCPS codes to support the visit.
- Document status codes: Document status codes such as amputations, ostomies, etc. when factual.
Certification and Training
- Certification options: Certification options include the Certified Coding Specialist (CCS) and the Certified Professional Coder (CPC) offered by organizations such as AHIMA and the AAPC.
- Education and training programs: Education and training programs in medical billing and coding are available in Iowa, including certificate, diploma, and degree options.
- Job prospects and salary expectations: Job prospects for medical billing and coding professionals in Iowa are excellent, with average salaries ranging from $13.50 to $38,400 per year.
Continuing Education
- Continuing education is crucial: Continuing education is crucial for maintaining certification and staying up-to-date with industry changes.
These are some of the key points and codes mentioned in the Iowa Total Care Coding Reference Guide and the medical billing and coding resources.