A research study on HIPAA compliance done by the Porter Research, NueMD, and the Daniel Brown Law Group in 2015 made a shocking revelation that around 40% of the healthcare organizations and healthcare billing companies were unaware of the updated compliance measures. In this group of companies, 42% did not even have a HIPAA compliance plan in place, which is one of the foremost mandates of the law! This study truly reflects the state of affairs and highlights the need for digging deeper into the system. Let’s see how!
The Health Insurance Portability and Accountability Act aims to eliminate the fallacies of sensitive health information management and make the system more robust. When you are outsourcing your medical billing and other revenue management work to healthcare billing companies, you must see to it that they are HIPAA compliant. Only then will you be safeguarded from data breaches and be able to maintain your ethical standards. But it can often get confusing with the constant changes.
This article will take you through the most frequently asked questions regarding HIPAA and how the law is significant to healthcare billing companies.
1.What is the purpose of having a law like HIPAA?
The medical information of an individual is sensitive in nature. Mishandling of such critical information can lead to complicated fraud cases. On one hand, this compromises the patient’s data. On the other hand, it tarnishes the reputation of the healthcare organization.
- HIPAA acts as an umbrella to protect the organization from all such cases of compromised information.
- The measures articulated under HIPAA target the multifaceted problems and try to resolve them.
- HIPAA sets some rules for handling patient data, which is often referred to as PHI (Protective Health Information).
- It secures and protects the information from falling into unauthorized hands.
- This leads to the reduction of fraud cases of healthcare information.
- HIPAA also targets the health insurance portability to eliminate the issues of pre-existing medical conditions.
2.What are the details covered under the PHI? How does HIPAA protect it?
Protective Health Information or PHI pertains to even an unborn fetus. Some of the crucial information under PHI means:
- Demographic details of the patient
- Medical records of the individual
- Any existing records for mental health conditions
- Results for any lab tests that the patient might have taken
- Insurance information of the patient
- In the case of a newborn or a fetus, information like body weight, height, temperature, or medical complications is noted.
The Electronic Health Records (EHR) accessed by the providers and the billing teams cover these details. One single breach in data security can cause a great compromise to the individual. HIPAA ensures that these crucial data points are secured in a robust electronic system.
3.Is HIPAA compliance mandatory for healthcare billing companies?
Yes! It is not an option but a mandate according to the rules set by the US Department of Health and Human Services. According to the federal policy, these rules are applicable nationwide for healthcare bodies like:
- Covered Entities: Any organization or individual related to treatment plans, payment methods, and any other medical operations of the concerned patient.
- Business Associates: Any organization assisting in any of the work done by the covered entities.
- Healthcare billing companies mainly fall under the business associate category since they have complete access to patient information.
However, the US Department of Health and Human Services also states that organizations like life insurance companies, employers, and worker compensation managers do not have to abide by the privacy and security rules of HIPAA.
4.What are the measures healthcare billing companies must follow to stay compliant?
The rules of the HIPAA compliance measures are comprehensively mentioned in the portal of the US Department of Health and Human Services. But if you are a beginner in this field, then the following checklist as highlighted by the HIPAA journal might be useful for you:
- Annual audits and assessments are conducted every year to get through with the systems in place.
- Analysis of the audit results shows the deficiencies in the existing workflow management and the need for action.
- The remediation plans should be carefully put in place targeting the compliance measures.
- In case the company is not well equipped to plan out the actions, they can also appoint HIPAA Compliance, Privacy, and/or Security Officers to get the system checked.
- Frequent checks are mandatory to know if the plans are working for the particular organization. Whatever be the result, they must be updated.
- The companies can also appoint Compliance Officers to conduct HIPAA training for the staff members of the organization. This will help them stay up to date with the modified rules.
- Staff training reviews are also extremely helpful in articulating the health of the company work management.
5.What questions should you ask when outsourcing to healthcare billing companies to see if they are HIPAA compliant?
When outsourcing revenue management work to healthcare billing companies, you should check well if they are trustworthy. Otherwise, you might run into unnecessary legal battles. Make sure you ask them these questions to know they are HIPAA compliant:
- Do you have any regular monitoring system to survey any potential hacking activities on your software system?
- What kind of restrictions do you follow when transferring or handling electronic PHI?
- Are your audit logs securely stored in all your systems (both hardware and software)?
- Do you conduct regular staff training programs to ensure patient privacy?
- Do you have properly defined security protocols regarding facility access?
- What kind of rules do you follow regarding authorized access to patient information?
- Do you conduct the annual security risk assessment as mentioned by HIPAA?
These questions should more or less cover all your risk points. If you are still a bit unsure about the systems, you can ask for the HIPAA compliance certification. Make sure you go through their customer reviews to get a clearer picture.
Hope this blog helped you to get more clarity on HIPAA compliance for healthcare billing companies. For more such news and articles on healthcare management and technology, please subscribe to our blog. Your feedback is valuable to us! In case of any queries, reach out to us and we will definitely get back to you. For regular updates, subscribe to our pages on Twitter, Instagram, Facebook, and LinkedIn.