HIPAA Medical Billing, medical billing services, medical practice, HIPAA compliance, Healthcare providers, HIPAA compliant medical billing, Protected Health Information, PHI, healthcare professionals, healthcare operations, medical billing and coding services, HIPAA Privacy Rules, Health and Human Services, medical practitioner, physicians

P3Care Explains the Three Rules of HIPAA Medical Billing

HIPAA or the Health Insurance Portability and Accountability Act is a measure introduced by the healthcare system to protect patients’ information and privacy regarding their health, financial, and insurance details.

And, this healthcare rule applies to all areas, be it care delivery, medical billing services, and insurance companies to a larger extent. Especially HIPAA medical billing is a thing that every medical practice must comply with.

In short, the patients have rights regarding the information they share and can ask questions about why it is required.

Involved Parties in Information Holding and Exchange

People that come under the HIPAA compliance rules are:

  • Health plan providers
  • Healthcare clearinghouses employees
  • Healthcare providers who conduct online or electronic transactions
  • Business associates of all these parties

Rules of the HIPAA Act

The HIPAA Act consists of 3 main rules:

  1. Privacy Rule
  2. Security Rule
  3. Breach Privacy Rule

HIPAA Privacy Rule

The HIPAA Privacy Rule sets the standard for information exchange regarding a patient’s health. This exchange is only allowed if the information somehow helps to coordinate the care of a patient.

It also gives a lot of power to the patients as they can restrict the amount of information given to healthcare. Moreover, HIPAA-compliant medical billing is also not obliged to provide information about procedures or treatments that they paid for in cash.

Patients can also do other things like:

  • Examine their medical records
  • Make changes to them
  • Obtain a copy of them
  • Give feedback to the clinician
  • Report abuse (child or otherwise) and negligence regarding a healthcare provider’s services

What is PHI?

PHI stands for Protected Health Information, which is an important part of healthcare and medical billing services. It is the information given by the patients during their visit to a clinic or a hospital.

It includes details such as:

  • Addresses
  • Physical and mental health conditions (past or present)
  • Provision of healthcare
  • All payments for the provision of future healthcare

Requirements of the Privacy Rule

The following need to be fulfilled when it comes to protecting patient’s information during claim compilation:

  • Inform patients about their rights and the usage of the information they give
  • Take on effective privacy procedures and hire staff who will follow them
  • Assign someone to overlook the exchanges so that nothing remains amiss
  • Secure the files containing patients’ information and make sure they don’t fall into the wrong hands

Information Exchanges with Other Healthcare Providers

Here are the instances in which you can exchange a patient’s details with other healthcare professionals.

  • Share a patient’s information with other doctors, healthcare services, and providers for the reasons of treatment, payment, and healthcare operations. Under these, we don’t need a signed consent form from the patient
  • Mention an incapacitated patient’s information if it’s in their best interests
  • Give their health information for research purposes
  • Share information with others over e-mail, fax, or telephones only if protective measures or safeguards are in place

Information Exchanges with Family Members 

A patient’s information can be shared with their family if:

  • A family member is in the patient’s care
  • The care of the patient is the responsibility of the family member

Also, add the basic contact information of the patient to the hospital directory. Such information is useful not just for the hospital staff but also for the medical billing and coding services.

Incidental Disclosures

The HIPAA Privacy Rule requires us to have policies that protect and limit the use and disclosure of PHI. But none of us are 100% foolproof, and we can’t guarantee that a patient won’t catch a peek of a form or overhear the details when a doctor is talking to a nurse.

Such cases do not come under the HIPAA breach category, provided we had all the HIPAA necessary safeguards in check.

Protecting Information While Using a Mobile Device

With telehealth and the automation of medical billing services, your data are always at stake. Keeping in mind, that hackers and malware are on the rise, we have several areas where you should be smart enough to ensure all ways to block any data thefts.

Some steps to avoid information leaks if you are using a mobile device are:

  • Use a password or some other form of authentication on your phone
  • Install and enable applications that offer encryptions, firewalls, remote disabling, security, etc.
  • Do not use file-sharing applications when using your phone to save patient information
  • Research mobile apps before downloading them
  • Have some physical control or a “kill switch” setup to halt things if something goes wrong
  • If you are sending or receiving healthcare data over public Wi-Fi, then use the necessary security measures
  • Delete all the healthcare data your phone contains before selling, changing, or discarding it

HIPAA Security Rule

This rule requires us to protect a patient’s privacy, especially in cases of ePHI’s confidentiality, integrity, and availability.

It can happen in the following ways:

  • Analyze security risks and come up with the required solutions
  • Protect against the unethical and impermissible use of someone’s private information
  • Hire employees who can learn to comply with measures for the protection of patient data

While developing safety measures, we need to consider the following factors:

  • Size, complexity, and capabilities
  • Cost of the required measures
  • Cost of technical infrastructures, such as hardware and software
  • Existing risks for the ePHI

HIPAA Breach Notification Rule

This rule is for the instance in which a patient’s information gets leaked or disclosed without permission.

In case of a breach of PHI, rules require us to notify the following parties.

  • The affected individual(s)
  • The Department of Health and Human Services (HHS)
  • The Media

That only happens when the unpermitted use or disclosure of the information compromises the privacy and security of PHI.

The criteria for measuring the degree of a breach are:

  • Nature and extent of information leaked
  • The person who has the information, and have they viewed it or not
  • The extent of risk reduction
  • Reporting of a security breach

In most cases, we need to report the breach to the appropriate authorities without any delay, no matter where it happens in any step of the medical billing services. And if it gets discovered later, it needs to be reported (at the most) within sixty days of its discovery.

Other things regarding reporting are:

Tiny Breaches

Tiny breaches of security are those that affect lesser than 500 individuals. They need to be reported to the HHS annually.

Business Associates

Business associates should notify a covered entity of breaches at their place of work or by those that happened because of the associate(s) themselves.


All of these rules are put in place to keep the patient’s data safe for a safeguarded environment. It is of the utmost importance that it doesn’t get into the wrong hands, as it contains sensitive information.

So, make sure that you are a HIPAA-compliant medical practitioner and medical billing service and it will benefit you and your patients/physicians to a great degree.

2 replies
  1. Lucila Del Mar
    Lucila Del Mar says:

    I’m curious to find out what blog system you happen to be utilizing? I’m experiencing some small security problems with my latest website and I would like to find something more secure. Do you have any recommendations?


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