It's a valid concern. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) has had a major impact on health care providers who do business electronically as well as many of their health care business partners. Many changes involve complex computer system modifications.

HIPAA compliance requirements have been standardized into 4 main aspects.

1) Electronic transactions and code sets
2) Security;
3) Unique identifiers; and
4) Privacy

One common misunderstanding is that you are required to only report electronically to be HIPAA compliant; however that isn't accurate. HIPAA does not require a health care provider to conduct all transactions and medical billing electronically. Rather, HIPAA dictates that if you are going to conduct any one of these business transactions electronically they will need to be done in the standard secure format outlined under HIPAA. So in a nutshell, you're not required to submit your medical billing claims electronically, however you must be HIPAA compliant if you do.

That's one of the main questions to ask when you're looking for a medical billing partner. First ask if they do electronic billing, then ask if their billing methods are absolutely HIPAA compliant. If you get a long pause or the rep doesn't seem sure exactly what you're asking, keep shopping. Another qualifying question can be to ask about the submissions process from start to finish and, that can be a big clue as to whether the medical billing company has secure transmissions.

Remember, when you're looking for medical billing partner, the best fit for your company may not be located near your practice. If you're using secure data transmissions, it opens the field for you to use any medical billing company you choose, as long as they meet your criteria for HIPAA compliance and other issues such as claims follow up and the handling of denials and rejections, on the rare occasions they will occur once you switch to outsourcing your medical billing.

It's expensive to keep up with the technology required to be HIPAA compliant in your billing and it's also difficult for your staff to keep up with the never ending changes in the CPT. If you are finding your staff is spending more time chasing claims then helping service patients, it may be time to give outsourcing your medical billing a long, serious look.

Labels: consulting, denials, hipaa, medical-billing, medical-coding, outsourcing, security