FAQs on RCM Regulations
The No Surprises Act aims to protect consumers facing surprise medical bills when receiving care from out-of-network providers in circumstances outside their control.
The act went into effect on January 1, 2022 for most consumers enrolled in individual and group health insurance plans.
The False Claims Act, originally passed in 1863 during the Civil War by Congress due to concerns about fraud by suppliers to the Union Army, has undergone numerous interpretations by Federal courts over the years, occasionally resulting in conflicting interpretations of the law.
As outlined in the statute, individuals who knowingly present a false claim to the government can face liability for triple damages and substantial penalties. Since its initial enactment, the False Claims Act has undergone several amendments.
The False Claims Act is the Federal government’s primary civil enforcement tool.
The Fair Debt Collection Practices Act (FDCPA) is a federal law that limits the actions of third-party debt collectors. The FDCPA prohibits debt collectors from using abusive, unfair, or deceptive practices to collect debts. The FDCPA covers the collection of debts that are primarily for personal, family, or household purposes.
The FDCPA states that debt collectors cannot:
- Misrepresent the amount of the debt
- Misrepresent whether the debt is past the statute of limitations
- Lie about the debt they are collecting
- Use words or symbols that falsely make their letters seem like they’re from an attorney, court, or government agency
The FDCPA’s stated purposes are:
- To eliminate abusive practices in the collection of consumer debts
- To promote fair debt collection
- To provide consumers with an avenue for disputing and obtaining validation of debt information
The Fair Credit Reporting Act (FCRA) is a federal law that protects the accuracy, fairness, and privacy of consumer information. The FCRA regulates how credit reporting agencies (CRAs) collect, access, use, and share consumer information. The FCRA was originally passed in 1970 and is enforced by the U.S. Federal Trade Commission, the Consumer Financial Protection Bureau, and private litigants.
The FCRA protects information collected by CRAs, such as credit bureaus, medical information companies, and tenant screening services. The FCRA requires that CRAs adopt reasonable procedures for meeting the needs of commerce for consumer credit, personnel, insurance, and other information.
The FCRA provides consumers with the following rights:
- Credit bureaus must provide your credit report to you when you ask for it.
- Credit bureaus must limit access to your credit information.
- A potential employer must get your written permission before accessing your credit report.
The FCRA also affords individuals a private right of action that can be pursued in federal or state court against CRAs, users of credit reports, and furnishers. In certain circumstances, individuals can obtain attorney’s fees, court costs, and punitive damages.
he Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that protects sensitive patient health information. HIPAA requires national standards to protect medical records and other personal health information. The law was enacted on August 21, 1996 and applies to health plans, health care clearinghouses, and health care providers.
HIPAA has four main purposes:
- Improve efficiency in the healthcare industry
- Improve the portability of health insurance
- Protect the privacy of patients and health plan members
- Ensure health information is kept secure and patients are notified of breaches of their health data
HIPAA violations occur when an organization does not follow the standards defined by the law. Many violations are related to accessing or sharing patients’ protected health information (PHI). Other violations can include not training staff or monitoring access logs.
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was signed into law by President Obama on February 17, 2009. The HITECH Act was part of the American Recovery and Reinvestment Act (ARRA) of 2009, an economic stimulus bill. The HITECH Act created incentives for healthcare providers to adopt electronic health records (EHRs) and improve privacy and security protections for healthcare data.
The HITECH Act applied to healthcare organizations and medical practices that benefit from the Medicare and Medicaid programs. The HITECH Act provided financial incentives to “eligible professionals” for the meaningful use of certified qualified EHRs. An eligible professional is generally a physician, though there are incentives for hospitals as well.
The HITECH Act also increased penalties for violations of the HIPAA Privacy and Security Rules.
