Managing HIPAA Issues at your medical practices


With the application of HIPAA, (Health Insurance Portability Accountability Act), health care organisations need to be cautious with whom to share the patient information. HIPAA calls for protection of the individual’s health information, at the same time; this privacy rule also permits limited disclosure of health related information to related entity of a person who needs patient care, thus, bringing on added responsibility for the staff.

Challenges faced: Introduction of HIPAA has proved to be a challenge for medical billing over the recent years with providers required to send claims electronically in compliance with the act, in order to receive their payment. Medical billing and insurance companies have both been affected because of the regulations imposed by HIPAA requiring additional waivers and increased documentation related to HIPAA. Moreover billing software used along with business processes – practice management service vendor, billing system and clearing house – also need to be re-looked so as to become compliant with the HIPAA.

Benefits to medical practice due to HIPAA: Efficiency and cost savings are some of the many advantages of using HIPAA standard transactions:

  • Electronic claims: the HIPAA rules require the Medicare claims to be submitted electronically. Most of the providers are able to electronically claim directly to their insurers
  • Patient satisfaction: an efficient HIPAA compliant billing system ensures patient information privacy hence improving patient satisfaction and in turn patient count for the physician

Electronic claims have proved to be a giant leap for the health care industry. Huge gains have been estimated by the analysts by implementing the transactions as per required by HIPAA.

Current move to HIPAA 5010: According to CMS Physician offices are seeing reductions to their revenues after the move to HIPAA Version 5010. Industry experts feel problems due to this transition has affected physicians, billing clearinghouses, and public and private insurance payers as well. There has also been a lack of uniformity with certain practices billing using the older HIPAA 4010 standards, with some health plans adjudicating those claims while some clearinghouses are automatically converting 4010 transactions into the 5010 format for payment.

Streamlining your billing system: Getting a separate billing system for your medical practice can be prove to be beneficial as being specialists in their field they can easily perform assessments of your practice, using the latest HIPAA regulations and standards, also improving the revenue cycle- leaving enough time for the health care staff to do their job and physicians to solely concentrate on patient care. billing for more than a decade now play an indispensable role in confirming to HIPAA while billing for health care organisations. They make sure that individually identifiable information on health is protected and there is no violation of the act. MBC serving various specialities in healthcare is constantly updated with all billing reforms along with HIPAA norms while billing, helping health care professionals to concentrate on their core job of patient care, rather than worry about proper implication of HIPAA and other reforms.

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