The Significance of HIPAA Compliance by Medical Billing Services
Currently, the healthcare system is going through a critical phase that involves shifting paradigms, from the volume-based model to the value-based reimbursement system. All of this is intended to minimize healthcare costs and raise the quality of care.
Quality Payment Program (QPP) came to life under MACRA branching out into MIPS and APMs. Eventually, better patient-reported outcomes (PROs) will decide the fate of those physicians participating in both these tracks. MIPS can be the silver lining that may change the entire face of US health care. In addition, participating in MIPS individually or in the form of groups entirely depends upon you.
When does HIPAA Compliance Comes in?
If you are a multiple services provider offering medical billing service along with MIPS consultancy, you must exhibit HIPAA compliance while handling PHI and the patient records. EHRs contain sensitive data that needs protection, hence, a secure network.
Ineffective medical billing services are the doctors’ dilemma of the recent times. It is a mandatory and an unavoidable part of professional care delivery. If you, as a physician, are not following proper guidelines set forth by governing bodies, to preserve and protect PHI, you are exposing yourself to several problems. If that information gets out, it can easily be used to financially and emotionally harm the people related to it. For instance, the alleged intruder may empty all your bank accounts by using a social security number. It is not difficult for a hacker, especially in the digital age. Lack of compliance with HIPAA, therefore, can be risky. You are not only making things difficult for yourself but also for the provider hiring your services.
HIPAA Compliance — An Integral Part of the Electronic Medical Billing Services
Why do we need to secure information provided in hospitals or private practices?
Keeping in view the financial aspect, your social security number is very much part of the PHI. If there is a breach, the consequences can be unimaginable. Those people who are free from ethical boundaries or have no respect for the law can easily manipulate those numbers and misuse them for personal gains.
There have been incidences in which the data was available to everyone without authentication. But the government took prompt action and resolved the situation. This kind of thing should never happen.
As a Business Associate, you are working on behalf of the provider which demands extra care and caution at your end to protect the data. HIPAA compliance makes sure companies follow this simple rule and take all the necessary measures to implement it. Your computers, communication network, and process security measures should be in place to have a foolproof system for all the information coming in and leaving out.
Protected Health Information (PHI)
PHI is anything from a patient’s name, address, phone number to the social security number and account number. It is basically everything.
It is better to be Safe than Sorry
Even after following the steps carefully, sometimes, you may fail to protect the information. Therefore, if you accidentally fail to withhold PHI as part of the medical system, you must report this incident to the Privacy Officer as soon as it happens. We are humans after all and thus makes mistakes.
Reporting will initiate a thorough risk assessment and investigation into the matter. Given that, Department of Health and Human Services Office for Civil Rights (HHS OCR) will take the lead and won’t rest until the issue gets resolved.
Severe Penalties for the Guilty
Guidelines released by the mutual understanding of HIPAA OIG (Office of the Inspector General) and the Healthcare Reform Act of 2010 are the standards for in-house and outsourced medical billing services. Following them will enforce safety measures around ePHI’s exchange and storage. With this in mind, scrutiny can also come into effect if PHI is mistakenly lost or stolen outside the assigned address. Hence, only by strict adherence and disciplined approach, you can keep away from fines and reputational losses.
Holding the Conscience Accountable — Achieving the Status of an Ideal Medical Biller
Protection of ‘patient medical information’ is the central idea here. The covered entities like providers and the payers must consider this information as vital and guard it physically, virtually and verbally. As a medical biller, you should not discuss it with someone irrelevant, who has nothing to do with it. You may call this adhering to ethical privacy, but if you, somehow, breach it, you can hold your conscience accountable. This is like recalling the significance in your head and training your subconscious of the implications of PHI leakage.
Prepare Yourself for an Extra-Load of Claims
Medicare enrollees, under the Healthcare Reform Act, are entitled to free screenings for cancer, diabetes, and HIV. This means more claims will be filed with MACs or Medicare administrative contractors. Medical billing services need to be ready for the additional workload so that their performance stays intact.
EHRs Simplify the Billing Process
Since we are past 2015, every medical facility, small or big, has EHRs and these systems must follow the electronic protocols. HIPAA compliance is part and parcel of your job as a medical billing specialist.
The mandatory EHRs assist in the process of medical billing. In the digital age, you need to be aware of any software deficiencies and try to overcome them as soon as you can.