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Detailed guide to Louisiana
The medical billing laws in Louisiana are primarily governed by the Louisiana Balance Billing Act (La. R.S. 22:1871 et seq.) and the Medical Lien Statute (La. R.S. 9:4752). Here are the detailed guidelines and laws:Louisiana Balance Billing Act (La. R.S. 22:1871 et seq.)
- Prohibition on Balance Billing:
- La. R.S. 22:1874 prohibits health care providers from "discount billing" and "dual billing" patients if the provider has contracted to be in the patient's health insurers' network.
- "Discount Billing" means any written or electronic communication issued by a contracted health care provider that appears as defined by La. R.S. 22:1872(9).
- "Dual Billing" means any written or electronic communication issued by a contracted health care provider that sets forth as defined by La. R.S. 22:1872(10).
- Liability for Excess Charges:
- La. R.S. 22:1874(A) prohibits contracted providers from billing, collecting, or attempting to collect from an insured patient any amount in excess of the applicable co-payment, deductible, or co-insurance.
- La. R.S. 22:1874(B) makes the provider liable for attorneys' fees and all costs if the provider maintains "any action at law" against the patient.
- Private Right of Action:
- The Louisiana Supreme Court has held that consumers have a private right of action under the Balance Billing Act, allowing them to seek legal remedies for violations.
- This private right of action is contractual or quasi-contractual in nature, subject to a 10-year prescriptive period.
- Class Actions:
- Class actions have been certified in balance billing cases, with the Louisiana Supreme Court upholding the certification in cases like Baker v. PHC-Minden, L.P..
- Consent and the Medical Lien Statute:
- The Medical Lien Statute (La. R.S. 9:4752) allows health care providers to assert a lien against an injured patient's third-party tort claim.
- However, the Louisiana Supreme Court has held that the Medical Lien Statute limits the lien to "reasonable charges and fees," which may not exceed the contracted rate.
Medical Lien Statute (La. R.S. 9:4752)
- Allowance of Lien:
- The Medical Lien Statute allows health care providers to assert a lien against an injured patient's third-party tort claim.
- Limitations on Lien:
- The lien is limited to "reasonable charges and fees," which may not exceed the contracted rate.
Additional Protections
- Notice and Disclosure:
- Health care providers are required to provide notice and disclosure to patients regarding their rights under the Balance Billing Act.
- Patient Rights:
- Patients have the right to choose a provider or facility in their plan's network and are not required to receive out-of-network care.
- Federal Protections:
- Patients are protected under federal law, which includes the No Surprises Act, and can contact the Department of Health and Human Services at 1-800-985-3059 for assistance.
These laws and guidelines provide a comprehensive framework for medical billing in Louisiana, ensuring that patients are protected from balance billing and that health care providers are held accountable for their billing practices.
The medical coding codes used in Louisiana are primarily based on the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and the Current Procedural Terminology (CPT) manual. Here are some key codes and guidelines:ICD-10-CM Codes
- ICD-10-CM Coding Overview:
- The ICD-10-CM is used for coding diagnoses in both inpatient and outpatient settings.
- It is a hierarchical system with three to seven characters, depending on the level of specificity required.
- ICD-10-CM Coding Guidelines:
- The ICD-10-CM manual provides detailed guidelines for coding, including rules for assigning codes, using modifiers, and handling missing or unknown information.
CPT Codes
- CPT Coding Overview:
- The CPT manual is used for coding procedures and services in both inpatient and outpatient settings.
- It is a hierarchical system with five digits, with the first digit indicating the category and the remaining digits indicating the specific procedure.
- CPT Coding Guidelines:
- The CPT manual provides detailed guidelines for coding, including rules for assigning codes, using modifiers, and handling missing or unknown information.
Louisiana-Specific Codes
- Louisiana Medicaid Codes:
- Louisiana Medicaid uses specific codes for certain services, such as dental services and mental health services.
- Louisiana Workers' Compensation Codes:
- Louisiana Workers' Compensation uses specific codes for work-related injuries and illnesses.
Medical Coding Training in Louisiana
- AAPC Training:
- The American Academy of Professional Coders (AAPC) offers training programs for medical coding and billing in Louisiana, including classroom and online courses.
- South Louisiana Community College (SLCC) Program:
- SLCC offers a 12-month Medical Billing and Coding program that covers medical terminology, anatomy, insurance, billing, and coding, as well as hands-on training for coding medical insurance claims.
- Central Louisiana Technical Community College (CLTCC) Program:
- CLTCC offers an online Medical Coding course that teaches students how to use the CPT manual and the ICD-10-CM to find medical codes for any disease, condition, treatment, or surgical procedure.
Certification and Experience Requirements
- Certification:
- Medical coders can obtain certifications like the Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or Certified Inpatient Coder (CIC) through the AAPC.
- Experience Requirements:
- The AAPC requires a certain amount of experience for certification, which can be waived by completing an 80-hour or more classroom course or an online course that meets the certification requirements.
Additional Resources
- Louisiana Healthcare Connections Code Editing:
- Louisiana Healthcare Connections uses HIPAA-compliant code editing software for physician and outpatient facility coding verification.
- Louisiana State University (LSU) ICD-10 Medical Coding:
- LSU offers an ICD-10 Medical Coding course that provides the knowledge and skills needed to understand, apply, and interpret ICD-10 codes.
These resources provide a comprehensive overview of medical coding in Louisiana, including the codes used, training programs, and certification requirements.