HIPAA (Health Insurance Portability and Accountability Act), which was first enacted in 1996 to improve the efficiency of healthcare delivery, has come to be recognized as the standard for electronic data interchange (EDI), security, and confidentiality of all healthcare-related data. The Act mandates: standardized formats for all patient health, administrative, and financial data; unique identifiers (ID numbers) for each healthcare entity, including individuals, employers, health plans and health care providers; and security mechanisms to ensure confidentiality and data integrity for any information that identifies an individual.
Healthcare providers exchange healthcare data for a variety of purposes: collaborative clinical management, national healthcare planning, and more importantly for medical billing. Medical billing is a series of tasks comprising claims submission, charge entry, denial management, payment posting, tracking of accounts, appointment scheduling and rescheduling, billing and reconciling of accounts, patient enrollment, patient scheduling and reminders, financial management reporting, AR management (insurance and patient), medical coding audits, insurance verifications; insurance authorizations and follow up of rejected claims. The sum total of these tasks is collectively called Revenue Management Cycle (RCM).
Providers at each of these RCM task are required to follow HIPAA norms. One of such predominant norms is electronic processing of billing and coding in accordance with the HITECH’s meaningful use criterion. Failure to comply may invite mandatory data breach notifications, heightened enforcement, increased penalties and expanded patient rights. The cumulative effect of these impositions may unduly delay claim realization, thereby affecting practice revenues. Providers may even face intense audit and scrutiny, which may be detrimental to their credibility and sustenance in a highly competitive healthcare industry.
Therefore, it is advisable that providers’ outsource proven, web-based framework that allows them to collaboratively manage their HIPAA/HITECH Act compliance initiatives including HIPAA Audits and HITECH Privacy Breach Management using a single, integrated solution. Using such robust system (an integrated EHR with EMR and PMS), they will be able to perform the entire range of clinical and operational functions in sync with the HIPAA norms. Once they have their clinical and operational functions (billing included) on the right track, it will be easier to expect unhindered and fast realization of claims. The advantage of engaging a HIPAA-compliant outsourcing company is that it assures confidentiality of patient and practice information in accordance with the norms laid down by the Health Insurance Portability and Accountability Act (HIPAA). This helps avoid unnecessary litigation and maximize claim reimbursement.
Medicalbillerandcoders.com comes across as a trusted name in HIPAA compliant medical billing and RCM services. For over a decade, we have been helping healthcare providers (across the 50 states in the US) realize maximum revenues through reliable HIPAA compliant practices.