Health Insurance Portability and Accountability Act (HIPAA) plays a crucial role in medical billing, coding, medical transcription, and patient appointment scheduling. The act stipulates security guidelines for the security of patient’s data.
For billing purposes, HIPAA helps to curb fraudulent activity before, after, and during the claims processing. It also helps to establish standards for transferring patient data electronically.
When managing a healthcare facility, medical professionals undoubtedly have different things to worry about. No doubt, medical coding, and billing is challenging to keep up with, especially with constantly evolving regulations, laws, and medical codes.
However, these changing regulations make it difficult to be compliant even for professional medical facilities. Unfortunately, failure to be compliant with the medical coding and billing system can lead to several negative ramifications for a healthcare facility i.e, security breaches, password attacks, information leakage, or data leak.
What risk do these Companies have to Face?
Because security breaches are always bad news in the sensitive industry of healthcare. When patient confidentiality and data privacy leak, it can negatively impact patient trust, overall medical practice reputation, and profitability can take a serious hit.
However, security problems impact medical billing on a daily basis. The healthcare industry is full of multiple stories that are making the rounds.
How greatly, did healthcare service providers have to pay, due to failure to comply with regulations for data security and safety.
Compliance is the only legitimate aspect for determining the key specialty of a medical biller, in the context of maintaining patients’ healthcare data privacy and security. That’s why adhering to the regulations and rules laid down in the comprehensive HIPAA is very crucial.
Need of HIPAA Compliance in Medical Industry
In 1996, legislators realized that HIPAA is the true need of the coming times. Because digitalization of businesses and data also means information leakage, this is a strong threat to all types of e-businesses. However, the medical insurance by HIPAA, ensures that a patient can enjoy full security. And their personal information remains private in the hands of HIPAA-qualified and skilled medical personnel. Briefly:
- HIPAA generally focuses on how PHI (Protected Health Information) and ePHI (Electronic Protected Health Information) are transmitted, accessed, stored, and shared.
- The HIPAA act enables the patients to dispute a representative for themselves.
- Patients can request copies of their healthcare history and change it whenever they want.
- It also requires the patient’s consent before sharing any personal patient data with other medical professionals or insurance carriers. On the other hand, patient consent isn’t compulsory for some procedures. Including coordinating care, billing purposes, protecting public health, reporting injuries (gunshot wounds) that fall under legal obligations.
Benefits to the Healthcare Organization
The major aim of this act is to prevent medical abuse, fraud and put a standard on how healthcare practices can conduct electronic billing, share healthcare information, and conduct other processes.
It works to develop the privacy and security of all kinds of medical data. As well, it gives a patient the right to access their medical history and how it is used.
HIPAA supports the electronic submission of a medical claim. This means minimum mistakes/errors and a significant increase in returns.
It improves efficiency in work processes, optimizes medical functions related to administration, and makes sure that the protected medical process is safely secured.
Trust is the backbone of every successful business, and HIPAA makes it easier for patients to trust their healthcare providers. As a result, medical practitioners can expand and collect more information from patients, because they have the capacity to secure their personal data. That encourages ongoing profitability for the medical practice.
When a healthcare practice retains more patients due to trustworthiness, it will increase profitability (Retaining existing patients means that your recurring cash flow maximizes).
The biggest advantage of ensuring HIPAA compliance is that medical practice would not get subjected to punitive action when a breach occurs. However, if HIPAA violations are identified, financial penalties and other threatened penalties (sanctions) can be imposed.
How Can You Stay Compliant with HIPAA Regulations
If your business has anything to do with medical information or health records, then HIPAA compliance is essential for you. Non-compliance with HIPAA rules may cause a big amount of fines to your healthcare organization. It will also negatively impact a practice’s reputation and cost thousands of dollars. That’s why to protect sensitive personal and healthcare information, entities must implement multiple safeguards or security measures into their system.
If it’s difficult for you to manage a 100% HIPAA compliance process in your system. Then outsourcing is one of the best decisions to gain patient satisfaction, trustworthiness, and profitability. These professional billing companies have in-depth knowledge of key state-level regulations and can help medical professionals take the necessary steps to ensure compliance.
Consider these protocols before hiring any medical billing company
Here are the following reasons that justify the fact that hiring a medical billing company makes sense when it comes to staying HIPAA compliance;
- A physical network and process security measures are in place.
- Security guarding the billing company on a 24/7 basis.
- Automatic log-off, unique user credentials, emergency access procedures, decryption, and encryption mechanisms.
- Password-protected computers.
- Restrictions when removing, transferring, disposing of, and even re-using electronic media.
- Put billing staff’s signature on agreements for confidentiality and non-disclosure.
- Antivirus and firewall software for each person’s computer.
- Established policies regarding the access and use of workstations and electronic media.
- On each computer, disabling the floppy disc and other external drives.
- Regular tracking logs and audit reports, that are securely recorded on their software and hardware systems.
Among other requirements, by fulfilling these, a healthcare practice will be on its way toward becoming HIPAA-compliant.
For billing agencies who are working in the US healthcare industry. The HIPAA set of regulations is the veritable Bible for data privacy.
Keep in mind that, adhering to its rules isn’t a matter of choice, but a compulsory requirement for any well-standard billing company.
All employees, within a medical billing company including medical billers and coders, are accountable for maintaining HIPAA compliance at their best. It’s because when it comes to medical billing it will help to eliminate fraudulent activity during the claim process.
