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HIPAA Compliance in Medical Billing

Insurance Portability and Accountability Act, or simply HIPAA. The 1996 act entails:

  • Data control laws
  • Safety rules
  • Warning rules on violations

The privacy rule under HIPAA allows protected health information (PHI) to be covered under the regulation of entities dealing with patients’ personal health information, including healthcare services and third-party medical billing services companies.

Importance of HIPAA Compliance in Medical Billing

HIPAA compliance in medical billing entails safeguarding the PHI in the billing process. The process includes the use, disclosure, and storing of PHI by:

  • Healthcare practitioners
  • Medical billing companies
  • Insurance provider companies

HIPAA compliance requires healthcare practitioners to implement physical, administrative, and technical safeguards to ensure PHI confidentiality, availability, and integrity. HIPAA compliance in medical billing involves:

  • Training of the employees over security policies and procedures.
  • Performing risk assessments.
  • Forming contingency plans in the event of a data breach.

Is Billing Information Protected Under HIPAA?

Most people understand that HIPAA protection applies to medical records and the details regarding healthcare services. However, they might need to comprehend that the HIPAA regulations apply to payment-related information. The shorter answer to this question is yes; billing information is protected under HIPAA regulations.

Best Practices for HIPAA Compliance in Medical Billing

Healthcare practitioners are responsible for keeping patients’ information safe during billing procedures and ensuring HIPAA compliance. Below are some of the best practices that healthcare professionals and billing providers can use to protect the Protected Health Information:

1. Develop and Enforce Security Procedures and Policies

Healthcare providers must implement and develop procedures and policies for protecting PHI during billing operations. The policies can be further customized to meet the specific needs of a healthcare provider. These can include physical, administrative, and technical safeguards for ensuring PHI integrity, availability, and confidentiality.

Training is yet another vital step towards ensuring HIPAA compliance in medical billing. Providers and billing companies must regularly train their employees on the security procedures to ensure that they understand the identification of security incidents and report them promptly. Furthermore, healthcare billing employees must also receive training on correctly identifying suspicious emails. They must also learn to secure electronic devices and report security incidents to appropriate personnel.

3. Secure Communication Channels to Ensure HIPAA Compliance in Medical Billing

Secure communication channels are essential, and healthcare providers must use secure communications for transmitting the PHI. Doing so entails using encrypted email and secure file transfer protocols to protect the PHI from illicit access, use, or even disclosure during the transmission.

4. Limiting Access to PHI

Furthermore, healthcare providers and billing providers must limit access to PHI to only a select number of employees who need it to perform their job functions. It can be easily ensured via access controls and the permission settings on the electronic systems and devices.

Advantages of HIPAA Compliance in Medical Billing

1. Moderation in Accountability

Physicians can work with virtual media without having limitations or fears of violating patient confidentiality. Furthermore, practitioners can also work without the fear of getting sued if their patients’ medical information is not confidential.
HIPAA has set up a fraud detection and prevention program. For instance, HIPAA forbids charging for treatments that have not been performed. HIPAA also prohibits falsifying diagnoses to justify inappropriate procedures and treatments for medical use. Furthermore, HIPAA also prohibits using incorrect methods for paying for non-insured services.

3. Creating Credibility and Patient Trust

Complying with HIPAA regulations will also encourage safeguarding patient medical records and personal information using the latest data management practices.

4. Circumventing Penalties

Paying hefty fines for instances of non-compliance shall use funds that can be used to advance business. While staying in compliance with the HIPAA regulations means that the procedures will not be punitive if a violation occurs.

5. One-stop Medical Needs Shops

Patients and doctors can use portals or apps to interact directly, dispense treatment, and enter or access medical data. Furthermore, the HIPAA-compatible prescription services can also be updated as such. Compliant apps or platforms make billing, coordination, and data storage easy without fear of HIPAA violation. All of this is much more simplified for healthcare professionals and billers.

Final Word – Seek a HIPAA Compliant Service Provider

HIPAA compliance in medical billing is essential to the success of a healthcare practice. The HIPAA violations are no small matter. The violators of HIPAA can be fined over 1.5 million and even face jail time for up to 10 years. It is essential to consider the fragility and importance of compliance to prevent such instances and then look for a professional medical billing provider.

Frequently Asked Questions

The 1996 HIPAA act is a federal law that necessitates the creation of national standards. These standards are devised to protect sensitive patient health data from being disclosed without prior consent and knowledge of the patient.
To prove HIPAA compliance, you must evaluate your practice operations against the HIPAA regulations. One easy way to do this is by auditing your practice/organization using the HHS OCR (Office of Civil Rights) HIPAA Audit Protocol.
Ideally, the Privacy rule covers the physical security and confidentiality of the PHI, even in electronic formats, in addition to oral or paper. HIPAA security rules protect ePHI (electronic PHI); created, received, used, or maintained.



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