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HIPAA Compliant Medical Billing Services
HIPAA Compliant Medical Billing Services ensure the protection of patients’ sensitive health information by adhering to the strict regulations set forth by the Health Insurance Portability and Accountability Act. Since its establishment by Congress in 1996, HIPAA has played a crucial role in safeguarding Protected Health Information (PHI), such as social security numbers, against unauthorized access and potential misuse. By implementing these stringent standards, HIPAA Compliant Medical Billing Services prevent data breaches, thereby protecting patients from financial, reputational, and emotional harm while maintaining the integrity of the healthcare industry.
We Believe in a Constructive Relationship
HIPAA is obligatory FOR two types of individuals or organizations – Covered Entities and Business Associates.
Covered entities include –
- Health plans
- Healthcare clearinghouses
- Healthcare providers who electronically transmit any health information.
The Business Associates include medical billing solutions or medical billing outsourcing companies, data hosting firms, etc. Any individual or a third-party organization which handles ePHI on behalf of the healthcare providers is a business associate.
Breaking It Down
HIPAA is divided into three essential rules: the Privacy Rule, the Security Rule, and the Breach Notification Rule, all of which are designed to protect patient information and, ultimately, the patients themselves.
At P3Care, we offer HIPAA Compliant Medical Billing Services that involve the electronic processing of claims. As such, we place a strong emphasis on the HIPAA Security Rule, which outlines the necessary safeguards for protecting electronic health information (ePHI). This rule requires the implementation of physical, technical, and administrative measures to ensure the security and confidentiality of ePHI.
The widespread awareness of HIPAA, fostered by the Office of the National Coordinator for Health Information Technology (ONC) in collaboration with the HHS Office for Civil Rights (OCR), has led to a greater understanding among providers of the importance of HIPAA compliance. At P3Care, we are committed to maintaining the highest standards of security and privacy in all aspects of our medical billing services.
WHAT IS HIPAA IN MEDICAL BILLING?
P3Care is a HIPAA medical billing company as it falls in line with the primary and extended principles of HIPAA. As a business associate, it conducts the risk assessment within organizations and pays ultimate regard to the PHI and ePHI. Being part of a digital age, we are in touch with the electronic versions on a daily basis, and, therefore, place all the respective safeguards for protection.
By performing a risk assessment, we exhibit HIPAA compliance and ensure an administrative, physical and technical safe zone to receive, store and transmit patient health information.
HIPAA REQUIREMENTS FOR ELECTRONIC CLAIMS
HIPAA medical billing insists the medical codes follow certain standards. These codes, as we know, form the basis of electronic claims. The medical billers and coders are bound by law to create & submit claims using an approved format. We know this format as ASC X12 005010 or HIPAA 5010.
HIPAA streamlines the ICD, CPT, HCPCS codes for diagnosis and treatment reporting
HIPAA COMPLIANT SECURITY RISK ANALYSIS BY P3CARE
HIPAA Compliant Medical Billing Services by P3Care are designed to help hospitals and medical practices avoid costly penalties by ensuring they meet all necessary compliance standards. Our HIPAA-compliant security risk analysis equips healthcare providers with the confidence to face OCR audits and builds trust among clients. For a medical billing outsourcing company like ours, maintaining a strong reputation depends on our adherence to these strict standards.
P3Care meticulously identifies key areas within healthcare organizations that may require additional security measures to prevent data breaches. By addressing these vulnerabilities, we help organizations become more secure and fully HIPAA compliant.
Reporting any security incidents where Protected Health Information (PHI) is accidentally exposed is also a critical component of HIPAA compliance. Additionally, our HIPAA billing services require the use of a specific Electronic Data Interchange (EDI) for billing tasks, ensuring that both medical billing and coding processes adhere to HIPAA guidelines.
By staying transparent about our compliance efforts, we strengthen our relationships with existing clients and increase our chances of earning new ones.
THE LEGAL AND ETHICAL RAMIFICATIONS OF HIPAA VIOLATIONS
There are some severe consequences for not following the provisions of HIPAA in letter and spirit. A few types of violations include ‘willful neglect’ and ‘reasonable cause’ being the most prominent among them. As covered entities, if you are guilty of any of these violations, you can face penalties in the form of fines and even more severe punishments. The following chart describes them in detail.
- HIPAA Violation
- Unintentionally
- Reasonable Cause
- Willful neglect but a violation is dealt with during the required time period
- Willful neglect but a violation is NOT dealt with during the required time period
- Minimum Punishment
- $100 per violation;Maximum $25,000 for repeated violations in a year
- $1,000 per violation;Maximum $100,000 for repeated violations in a year
- $10,000 per violation;Maximum $250,000 for repeated violations in a year
- $50,000 per violation with a maximum penalty of $1.5 million in a year
- Maximum Punishment
- $50,000 per violation; Maximum $1.5 million in a year
- $50,000 per violation;Maximum $1.5 million in a year
- $50,000 per violation;Maximum $1.5 million in a year
- $50,000 per violation with a maximum penalty of $1.5 million in a year
OUR SERVICES
P3Care executes a security risk assessment plan but it depends on the size of your practice. The bigger your organization is, the greater the time required to analyze it.
Expect the following things when you choose us –
- We assign a privacy and security officer within the medical practice
- Devise and write an elaborate plan of rules and regulations
- Hospital staff HIPAA training is part of the package
- Risk assessment includes screening all the pathways of PHI
- Recovery plans if the PHI is lost or there is a data breach
- Systematic disposal of ePHI when necessary (CVS pharmacy was heavily penalized for improper disposal of patient health information)
- Security incident checks, how and when to file an incident to the OCR
THE THREE-HEADED SECURITY
All the covered entities and business associates must have a well-thought-out security plan. The HIPAA Security Rule has three basic components.
- Administrative Safeguards
These security measures pinpoint the risks; By designating a security officer, executing a plan to prevent unauthorized access, training the hospital staff and supervising them, analyzing the security rules and regulations from time to time, we are well-set on a HIPAA acceptable journey.
- Technical Safeguards
These security standards mean restricting access to facilities, laptops, desktops, tablets and other mobile devices which contain ePHI. Passing the information through encryption mechanisms is the right way to handle sensitive information.
- Physical Safeguards
These measures identify the rules and regulations that must be in place to ensure data integrity. The electronic information, buildings, and the equipment need protection from natural and environmental disasters, unauthorized access and any other hazardous events that may jeopardize the patient health information.
HIPAA
- Don’ts
- Don’t keep patient details (paper-based) by the front desk
- Don’t log in to access PHI from non-secure mobile devices or networks
- Don’t open patient records without any valid reason
- Don’t speak about patient details in public, especially on social media
- Do’s
- Create procedures and make sure the Staff understands them
- Review the processes and every stage from which PHI passes, regularly
- Perform risk assessment at least once every year
- Implement provisions in letter and spirit and keep a close eye on controls
For questions out of this service, or on instructions on how to get started call a medical billing service expert today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@p3care.com.
We primarily provide HIPAA medical billing services and MIPS consultancy, among other services. As your HIT consultant, we optimize providers’ performance for improved RCM.
3200 E Guasti Rd Suite 100, Ontario, CA 91761, United States
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