HIPAA and Billing

HIPAA protects insurance coverage limitations, ensures patient privacy and security, and helps to prevent healthcare fraud, waste, and abuse.

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What is HIPAA?

In 1996, as a response to protect patients, the United States Congress enacted the Health Insurance Portability and Accountability Act, otherwise known as HIPAA.

Health Care Access, Portability, and Renewability.

Deals with the limits to which an insurance provider can withhold coverage from an individual due to a preexisting condition or other circumstance.
This part of the HIPAA legislation is not usually a concern for medical offices, since it deals mostly with insurance companies.
If you encounter a patient that’s having problems with their insurance company, you should refer them to their employer’s HR department or state department of insurance.

Preventing Healthcare and Medical Billing Fraud and Abuse, Administrative Simplification and Medical Liability Reform..

Deals with the practices of healthcare providers, medical coders and billers, and other office personnel. This part of the HIPAA legislation enacts many specific rules and regulations on the way a health care office is run, claims are billed, and patient information is shared. Medical offices are usually most concerned about the Title II enactments of HIPAA, as they deal directly with the way medical offices are run on a daily basis.

Congress designed this Act, still in full effect, to regulate the medical industry. This includes:

hipaa compliance email security for healthcare industry

The government has acknowledged and standardized electronic claims through the Health Insurance Portability and Accountability Act (HIPAA). This act does a number of things in addition to regulating electronic medical transactions

Protects the insurance coverage of workers after they lose or change their job
Protects the privacy of patients’ medical information
Establishes standards for electronic medical transactions
Sets up rules and punishments for fraudulent medical reporting practices

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Electronic transactions

When HIPAA was passed, an increasing number of medical transactions were being performed electronically. While electronic transactions (like claims) were faster, more cost-efficient, and less error-prone, they also caused some patients and regulators to worry about the privacy of the personal medical records. Title II addresses these concerns and establishes standards and guidelines for these types of transactions.

Electronic Data Interchange (EDI)

HIPAA, in fact, standardized medical codes and established the Electronic Data Interchange (EDI) form that we use to send claims electronically. This EDI, called ASC X12, has a number of types, each of which corresponds to a certain type of transaction between (typically) a provider and a payer.

HIPAA also sets standards for how providers interact with and store the information of their patients.

Under Title II, all electronic transactions must be performed as a type of Electronic Data Interchange (EDI). (An EDI is a standardized form of electronic transaction. It’s widely used in all types of commerce. An ATM withdrawal, for example, uses an EDI). For healthcare transactions, providers and payers must use the EDI approved by the Accredited Standards Committee X12 (ASC X12).

Under Title II, each medical transaction has to adhere to a certain format. HIPAA dictates that those electronic transactions follow the format laid out by the ASC X12. This form is the ASC X12 005010. Included in that form are various subforms, each of which corresponds to a certain type of medical transaction.

Title II lays out a set of security guidelines that ensure the safety of both physical and electronic records. These regulations limit who can view medical information, and also dictates how this information is transferred.

Title II also established a set of rules limiting who can distribute your medical information, and when. These rules give patients more control over their medical records, including who can access them and at what times. These rules prevent anyone—including providers, payers, or government agencies—from viewing or distributing a patient’s medical information for anything not related to treatment for the patient. For instance, on a worker’s compensation claim for a broken finger, a biller would not include the patient’s history of heart disease.

TITLE II AND MEDICAL BILLING

Administrative Simplification

The passage of HIPAA added an “Administrative Simplification” (AS) to a portion of the Social Security Act. With the AS, Title II established a set of regulations and guidelines for the electronic transmission of healthcare data, and set up guidelines for the code sets used in medical billing and coding.

Civil and Criminal Punishments for these Fraudulent Offenses.

In addition to establishing the above regulations and rules, Title II also outlines a number of offenses related to healthcare and prescribes civil and criminal punishments for these fraudulent offenses.

National Provider Identifier (NPI)

Title II establishes the mandatory use of National Provider Identifier (NPI) numbers. You should remember NPIs from our discussion on creating medical claims. These NPIs are ten characters long, may be alphanumeric, and are never re-used (except in very particular situations). Like ICD or CPT codes, NPIs provide an efficient universal shorthand for identifying a crucial part of the healthcare process.

ICD codes, CPT codes, and HCPCS codes

We ‘ve actually already learned about many of these code regulations: HIPAA formalized the use of ICD codes, CPT codes, and HCPCS codes for use in creating claims. The goal of the AS was to establish a regular, uniform method of communication for any party involved in healthcare, such as insurance payers, providers, clearinghouses, and government agencies. All bodies covered by HIPAA (and this includes most providers and payers, including Medicare and Medicaid) must adhere to these standards of transactions.

We are HIPAA Compliant!

Under all the above mentioned HIPAA’s Privacy Rule and activity. We NAHL have undertaken various steps and designed our process to ensure we are fully compliant and trained.

1- SECURE Firewall

Our entire network is very secure. All clients’ office records are temporarily stored behind a secure firewall before deletion and all electronic claims are securely encrypted for transmission.

2- Confidentiality

Your privacy and security are given the highest priority at NAHL. Our company ensures that all the changes and updates made by HIPAA are properly and correctly communicated amongst the team to ensure highest standards of security and confidentiality.

3- Agreement

Each member enters into a confidentiality agreement, the terms of which state that they agree not to use, publish or disclose, or permit others to use, any confidential information they may come in contact with.

4- Termination

Violation of this agreement warrants termination and legal action.

5- Biometric Access Screening

Access cards and biometric access screening control entry of employees into the facility.

6- Restricted Area Control

Access to critical areas such as the server room is restricted and only authorized personnel have entry rights to these sensitive areas.

7- Access to computer

Full Internet/Email access is provided to only authorized personnel. Access to computer systems is restricted by logins and passwords, which is unique for every employee.

8- Completely Paperless Environment

Mainly for security and as a consequence, a ‘Go-Green’ initiative as well. Connections to the clients’ servers are through secure site-site VPN tunnels with 128-bit encryption.

9- Compliance Management Processes

A dedicated Compliance Officer ensures compliance management processes, which are updated regularly and are stringently adhered to.