Medical Billing and Article 28 - A Short Guide

What is article 28 medical billing software, and why is it necessary?

Depending on where you are in the country and how much you have heard about medical billing and coding laws, you may have heard about Article 28.

Article 28 is a New York State public health law which recognizes and regulates the accreditation of public health care facilities.

These facilities include:

  • hospitals
  • nursing homes
  • diagnostic and treatment centers
  • free-standing ambulatory surgery centers
  • and acute care clinics.

In other words, in the state of New York, Article 28 is the part of state law that makes sure that public health care facilities are legitimate and properly-operated.

Before a medical facility is built it has to pass the proper surveys and other regulations to make sure it meets all requirements. After this, it is given an operating certificate as an Article 28 facility.

Why become an Article 28 facility?

Why should your facility become Article 28 certified?

You may be wondering why any medical facility would put itself through the rigorously detailed and complex process of Article 28 certification.

The answer is simple!

Article 28 certified facilities participate in Medicare, Medicaid, and private health insurance plans with a higher rate of reimbursement than that of non-certified facilities.

This higher rate of reimbursement is meant to reflect the higher standards of the health practice, as well as to recognize the difficult process of certification and keeping up to date with Article 28 standards.

What does Article 28 have to do with medical billing?

Because Article 28 is such a rigorous process it results in higher rates of reimbursement than in typical medical billing and coding. There is more on the line than in a non-Article 28 medical facility.

It's even more important to make sure that when you're billing or coding in an Article 28 medical facility, you're using the correct software and performing to the best of your abilities.

Being a medical biller or coder in an Article 28 facility is a more demanding job than it would be otherwise. You have to be on the top of your professional game.

You also have to use the appropriate type of medical billing software. It has to be compliant with all Article 28 privacy and other regulations to maintain the certification.

Medical Billing Article 28 software

Using the right medical billing software eliminates lost or duplicate claims, and reduces the amount of time lost on managing claim denials and resubmissions.

All practice management programs that process and send Article 28 claims are HIPAA compliant, using computer-based patient medical records.

Medical Billing Article 28 training

Becoming Article 28 certified can help your facility earn more money

Although there is no mandate regarding the professional credentials of Article 28 billers, there are important standards that they need to maintain.

These include knowing about the requirements of Article 28 medical billing, knowing how to use the appropriate Article 28 medical billing software, and knowing all of the other basics of medical billing or coding.

You may be able to find accreditation or certification programs which certify your ability to accurately and correctly process and send Article 28 medical claims.

These programs or schools may also provide you with the correct Article 28 medical billing software, sometimes free to their students.

The appropriate training in Article 28 medical billing gives employers, providers, and the health department the confidence that all of their hard work will be properly reported and coded on claims, and that the medical billing department is in safe hands.

Furthermore, because Article 28 results in higher reimbursement rates, billing and coding these types of claims means that the medical practice will be getting paid more, which may positively affect your rate of pay in the future!

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