Medical Insurance
Medical Billing and Coding

Who regulates medical billing?

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2014-11-14 17:54:10
2014-11-14 17:54:10

Answer The American Medical Association, which consists of a voluntary membership of doctors, was consulted by Medicare, but ultimately it was Medicare that decided on the system for medical billing and that was later adopted by private insurance companies. Medicare is run by the federal government to provide health insurance for people over age 65 or disabled people and, like all good government departments, is accompanied by an alphabet soup. It was administered by HCFA - Health Care Finance Administration funded by FICA - Federal Insurance Contribution Act. HCFA has recently been renamed CSM. The bottom line is that the whole system was devised by the government. There are several sets of codes used for determining charges. For example E&M codes are used by doctors running outpatient practices. Every possible diagnosis has a code consisting of five digits. Hospitals use another set of codes and medical procedures such as surgeries are described by their own codes. There are thousands of pages of regulations concerning these codes and billing methods, and you can get a degree in the subject. -DJ Craig

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