QUESTION:
As Salaamu Alaikum,
I have a question in regards to medical billing in which a company maintains contracts with doctors as clients who work for hospitals or their own clinics. The company receives and records the doctors procedures and diagnoses for each patient and date of service, and stores this data with a CPT and ICD-10 code. The company bills the insurances and also bills the patient where applicable and keeps a record of any payments against the balance. Different insurance companies pay varying amounts for procedures but the highest payment amount is what is billed to all insurances and any adjustments, interest, deductible, denials, and takebacks are also recorded. And reports are submitted to the doctor.
What is the sharee hukum for:
Running such a company
Working for such a company as an employee
The income gained from running such a company
The income gained for Working for such a company as an employee
ANSWER:
As Salaamu Alaikum,
Medical billing done by a company is where the company bills an insurance company or the patient to pay fees associated with medical care by a doctor or medical care provider.
The Medical billing company simply uses the information regarding the patient’s visit to the doctor, the procedures and the diagnosis of the doctor, and creates a claim for all these services. The claim is then sent to the insurance company and then to the patient, if all the expenses cannot be fully paid by the insurance company.
From the above, it is evident that the Medical billing company acts as an intermediate point between patients on one side, and healthcare providers and insurance companies on the other side.
In this setting, one of the main responsibilities of the Medical billing company is to ensure that the healthcare provider is properly reimbursed for their services.
Storing the data with a CPT and ICD 10 code, simply means that all information regarding the patient’s visit to the doctor which has been taken by the health clinic/hospital is stored in the form of codes. The Medical billing company takes the written information and translates it into codes which is then used in the billing process.
The ICD code refers to the ‘International Classification of Diseases’ code which corresponds to a patient’s injury and sickness, and the CPT code refers to the ‘Current Procedure Terminology’ code which relates to what functions and services the healthcare provider performed on the patient.
With the above explanation of what a Medical billing company does, it is established that running such a company is permissible in Islam, since they provide work and services that are lawful in Islam to healthcare facilities and organizations.
Working for such a company as an employee is permissible, and the income gained from running such a company and also working for it will also be halal (lawful), since the source of the income is through lawful means.
Billing the Insurance companies is permissible, since in a number of countries medical insurance is essential for everyone to access healthcare. In this case, the insurance company takes the responsibility to offset the expenses of the patient, and the patient continues to pay a premium towards the insurance policy either directly or via the company he/she works for. As such, monies paid by insurance companies would be what is paid by the patient or his employer.
And Allah Knows best
Mufti Waseem Khan
18/05/2023