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Idaho

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Detailed guide to Idaho

The Idaho Patient Act (IPA) and related laws govern medical billing practices in Idaho. Here are the detailed guidelines and laws:Key Requirements

  1. Submission of Charges:
    • Health care providers must submit charges to the patient or the patient’s insurance company within 45 days of providing services or the date of discharge from the hospital.
    • If no insurance information is available, the claim must be sent to the patient. Missing this deadline limits the ability to recover costs and fees.
  2. Consolidated Statement of Services:
    • Within 60 days of providing services, the patient must receive a consolidated statement of services that includes:
      • Patient name and contact information
      • Health care facility name and contact information
      • Date and duration of the patient’s visit
      • General description of the goods and services provided
      • List of billing entities and their contact information
      • A clear and conspicuous notification stating "This Is Not a Bill".
    • The statement can be emailed if the patient has given permission, or it can be handed to the patient in person. If mailed, it must be sent within 57 days of providing services, and the statute presumes it is received three days after mailing.
  3. Final Statement:
    • The health care facility must send the patient a final statement that includes:
      • Patient and health care facility name and contact information
      • List of goods and services provided
      • Initial charges
      • Statement that a full itemized list is available upon request
      • Third-party payors and their contact information
      • Detailed description of reductions, adjustments, offsets, and payments received
      • Final amount the patient is liable to pay.
    • There is no specific timeline for sending the final statement, but interest and fees cannot be charged until 60 days after the patient receives it, and extraordinary collection actions cannot be pursued until 90 days after the patient receives it and all appeals, internal reviews, and good faith disputes have been resolved.

Extraordinary Collection Actions and Attorney Fees

  1. Attorney Fees:
    • Attorneys’ fees are generally capped at $350 for an uncontested judgment and $750 for a contested judgment. Health care facilities can appeal if the amount awarded is grossly disproportionate to their costs and the patient is then awarded supplemental costs, expenses, and reasonable attorney’s fees.
  2. Penalties for Non-Compliance:
    • If a medical provider is found to have willfully or knowingly violated the statute, the court can award up to three times the amount of the patient’s actual damages or $3,000, whichever is greater, plus the patient’s costs and reasonable attorney’s fees.

Additional Requirements

  1. Confirm Patient Information:
    • Confirm the patient’s insurance information and contact information at every visit.
  2. Documenting Statements:
    • Document when and how all statements are sent, and obtain patient signatures acknowledging receipt if delivered in person.

Recent Amendments

  1. Extension for Pre-July 1, 2021 Services:
    • Due to the COVID-19 pandemic, medical providers can pursue extraordinary collection actions even if they did not meet the timing requirements for services provided before July 1, 2021. This extension is only applicable for services provided before July 1, 2021.

No Surprises Act

  1. Protection from Unexpected Medical Bills:
    • The No Surprises Act provides protections for certain unexpected or excessive medical bills. Effective January 1, 2022, it ensures that consumers are not surprised by unexpected medical bills for emergency services or non-emergency services received from out-of-network providers.

These guidelines and laws aim to improve transparency and fairness in medical billing practices in Idaho, ensuring that patients are better informed and protected from excessive medical debt collection fees.

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The medical coding system used in Idaho is primarily based on the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) systems. These codes are used to represent services provided to patients and are essential for accurate billing and reimbursement.ICD-10 CodesICD-10 (International Classification of Diseases, 10th Revision) is used for diagnosis codes. It is a hierarchical system that categorizes diseases and health issues into different codes. These codes are used to document patient diagnoses and are essential for accurate billing and reimbursement.

CPT Codes

CPT (Current Procedural Terminology) is used for procedure codes. It is a system developed by the American Medical Association (AMA) that categorizes medical, surgical, and diagnostic procedures into different codes. These codes are used to document the services provided to patients and are essential for accurate billing and reimbursement.

HCPCS Codes

HCPCS (Healthcare Common Procedure Coding System) is used for non-physician services, such as durable medical equipment, prosthetics, and orthotics. It is a system developed by the Centers for Medicare and Medicaid Services (CMS) that categorizes these services into different codes.

Medical Coding and Billing Certification

To become a certified medical coder or biller in Idaho, you can pursue certifications from organizations like the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC). These certifications demonstrate your expertise in medical coding and billing and can enhance your career prospects and earning potential.

Medical Coding and Billing Job Prospects and Pay

The demand for medical coders and billers in Idaho is on the rise, with an expected 17% growth over the next eight years. The average yearly income for medical billers and coders in Idaho stands at $35,330, with higher-end salaries reaching up to $49,000 annually, depending on experience and location