HIPAA Compliance: Health Insurance Portability and Accountability Act requirements for protecting sensitive patient health information, including privacy rules, security rules, and enforcement rules
HITECH Act: Health Information Technology for Economic and Clinical Health Act provisions regarding electronic health records and enhanced HIPAA privacy and security protections
False Claims Act: Federal law that imposes liability on persons and companies who defraud governmental programs, particularly relevant for Medicare/Medicaid billing
Anti-Kickback Statute: Criminal law that prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce referrals for items/services covered by Medicare, Medicaid, or other federal healthcare programs
Stark Law: Physician self-referral law that prohibits physicians from referring patients to entities with which they have a financial relationship
Medicare/Medicaid Billing Requirements: Specific guidelines and requirements for submitting claims to Medicare and Medicaid, including proper coding and documentation standards
IRS Independent Contractor Guidelines: Federal requirements for properly classifying workers as independent contractors versus employees, including behavioral control, financial control, and relationship factors
State Labor Laws: State-specific requirements governing independent contractor relationships, including classification tests and worker protections
Data Security Requirements: Technical and administrative safeguards required for protecting electronic health information, including encryption and access controls
Insurance Requirements: Professional liability, errors and omissions, and cyber liability insurance requirements for medical billing contractors
Documentation Standards: Requirements for maintaining proper documentation of billing activities, including record retention periods and audit trail requirements
Business Associate Requirements: HIPAA-mandated provisions for business associates handling protected health information, including required contractual terms
Compliance Program Requirements: Mandatory compliance program elements, including training, monitoring, and reporting procedures for medical billing operations
CMS Guidelines: Centers for Medicare & Medicaid Services guidelines for proper coding, billing procedures, and documentation requirements
State Privacy Laws: State-specific requirements for protecting patient privacy and handling medical information, which may be more stringent than federal requirements
