Category/ Medical Billing

The Most Commonly Asked Questions About HIPAA Compliance

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A study on HIPAA compliance conducted by Porter Research, NueMD, and Daniel Brown Law Group discovered that approximately 40% of healthcare organizations and healthcare billing companies are unaware of the updated compliance measures. There were 42% of companies in this group without even a HIPAA compliance plan, which is one of the most important elements of the law! It is clear that this study reflects the state of affairs and that the system needs to be examined in more depth. Let’s find out!


By tackling the pitfalls of sensitive health information management, the Health Insurance Portability and Accountability Act aims to improve the security of the system. It is important to make sure that the healthcare billing companies you hire are HIPAA compliant when you contract with them to handle your medical billing and other revenue management needs. Having data protection ensures you maintain your ethical standards and protects you from data breaches. With the constant changes, it can often get confusing.


In this article, we will discuss why the HIPAA law is important to healthcare billing companies and how it impacts them.


In what way does a law like HIPAA serve its purpose?

A person’s medical information is sensitive by nature. Fraud cases can become complicated if such information is mishandled. In one way, the patient’s data is compromised. On the other hand, it damages the reputation of the healthcare organization.

1.       HIPAA acts as an umbrella to keep an organization safe from all forms of information breaches.

2.      HIPAA implements measures that address multiple areas of concern and try to resolve them.

3.      HIPAA regulates the handling of patient data, also called PHI (Protective Health Information).

4.     Information is protected from being compromised and falling into the wrong hands.

5.      In turn, this reduces the number of healthcare fraud cases.

6.     As part of HIPAA, pre-existing conditions are eliminated through health insurance portability.


What kind of information is covered by PHI? How does HIPAA protect the information?

Protection of health information, or PHI, is applicable to even an unborn fetus. The key information under PHI includes:

·        Details about the patient’s demographics

·        Documentation about the individual’s health

·        Any mental health records that exist

·        The patient’s lab results, if he or she has taken any tests

·        Details of the patient’s insurance

·        For a newborn or a fetus, information like body weight, height, temperature, or health problems is written down


The provider and billing teams access electronic health records to view these details. An individual’s privacy can be deeply compromised with a single breach of data security. Thankfully, HIPAA provides a robust electronic system to protect these sensitive data points.


Is HIPAA compliance mandatory for healthcare billing companies?

Yes! Regulations set by the US Department of Health and Human Services deem this as a mandate instead of an option. Following federal policy, these rules are applicable nationwide for healthcare organizations including:


Covered Entities: Any entity involved in the patient’s treatment plan, payment method, or any other medical procedure.


Business Associates: Any organization that assists covered entities in their work.

Since they have access to patient information, healthcare billing companies generally fall under the business associate category.


According to the US Department of Health and Human Services, HIPAA’s security and privacy regulations do not apply to organizations such as life insurance companies, employers, and workers’ compensation managers.


What are the steps healthcare billing companies must take to stay compliant?

Health and Human Services website provides comprehensive information about HIPAA compliance measures. The HIPAA journal suggests the following checklist for those just entering this field:

·        To ensure that the systems are functioning properly, audits and assessments are conducted annually.

·        An analysis of the audit results indicates a need for improvement in workflow management.

·        Implementing the remediation plans aimed at ensuring compliance should be carefully planned.

·        If the company isn’t able to plan out the steps, it can conduct a system check by appointing a HIPAA Compliance, Privacy, and/or Security Officer.

·        A periodic review of the plans is necessary to determine if they are working for each organization. Regardless of the outcome, updates must be made.

·        Companies can also hire Compliance Officers to conduct HIPAA training for their staff. By doing so, they will remain informed about the modified rules.

·        Reviewing staff training is also a great way to find out how well the company is managing its work.


What questions should you ask a company that handles your health care billing for you to make sure they follow HIPAA?

To ensure that healthcare billing companies are trustworthy, check out their reputation before outsourcing revenue management work. Otherwise, you might end up in unnecessary legal disputes. Check if they are HIPAA compliant by asking these questions:

1.       What regular monitoring systems do you have in place to check for potential attacks on your software systems?

2.      Can you explain the kinds of restrictions you follow when you transfer or handle electronic PHI?

3.      How secure are your audit logs across your hardware and software systems?

4.     Are you regularly training your staff to ensure patient privacy?

5.      Are you following proper security protocols when it comes to facility access?

6.     What kind of policies do you follow in terms of authorized access to patient information?

7.      Do you conduct a yearly assessment of security risks as required by HIPAA?


Hopefully, these questions cover most of your potential risk points. You can request a HIPAA compliance certification if you are still unsure about the systems. Take a look at their customer reviews to get a better idea.


This blog intends to provide you with more clarity regarding HIPAA compliance for healthcare billing companies. Please let us know what you think! Whenever you have questions, feel free to contact us and we will get back to you.


Think about Scribe Align Medical Billing.

If you’re interested in outsourcing medical billing for your practice, we can assist you. Practices need to maintain profitability so that accurate billing processes are followed. Our billing experts understand the complexities of revenue cycle management.

Differences between Physician Billing and Hospital Billing

Physician Billing vs. Hospital Billing: Understanding the Key Differences


Physician billing and hospital billing are the two types of medical billing that prevail in the healthcare industry. But what is the difference between hospital billing and physician billing?
This post will cover some essential points regarding the difference between physician billing and hospital billing, which will help you understand what factors come into play while learning about these two types of healthcare claims.


With physician billing and hospital billing, there are specific differences to tackle. For instance, physician billing is based on the percentage of the remuneration earned through procedures or a price for different services rendered. As for hospital billing, its based on the pricier reimbursement model, where the hospital charges the patients insurance plan for the services required and received.


Professional billing relates to physician billing, and institutional billing refers to hospital billing. In the healthcare industry, professionals differentiate between these terms depending on the purpose of the billing process and the services involved. The two methods, however, fall under the general medical billing process.


To highlight the key differences between physician and hospital billing, lets find out how they are used in both cases.


Physician billing: What is it?

Physician billing, or professional billing, refers to the billing process. Where claims submitted by physicians and healthcare providers are reimbursed when performing medical services or procedures on patients covered by insurance, once you decide to become a physician billing service provider, you must help the physicians or healthcare providers with claim submission and other related billing and collection tasks.

CMS-1500 or 837-P is the claim form used for physician billing. The only difference between these forms is that the CMS-1500 is a paper document, and the 837-P is an electronic document.
•    Some insurance companies, like Medicaid, Medicare, and others, only accept electronic claims as payment methods. P stands for professional configuration on the 837-P claim form, an electronic version of CMS-1500. Most of the time, expert physician billing services have more to do than institutional or hospital billing services.
Billing a doctor is an important administrative task that controls many other tasks in a medical office, like making appointments, greeting patients, registering patients, and collecting payments. 
To make sure that the organizations overall financial and operational goals are met, people who work in medical billing and coding need to know a lot about the policies and practices of physician billing. Because physicians bill insurance companies directly for patient services, a medical offices billing department relies on the accuracy of coding and claims processing to ensure that payments are made promptly. 
The organizations ability to stay in business depends on how much money it gets for each service it provides. Medical professionals can improve their ability to collect payments by learning the basics of physician billing.
•    Both inpatient and outpatient services can be billed under physician billing; both types can only be billed after patient verification.
•    All outpatient and inpatient services will be billed based on the patients insurance policy, so its important to check.
•    It is important to keep in mind that physician billing includes medical billing and medical coding as well.
Therefore, medical billers need to learn both billing and coding procedures. Healthcare professionals offices and hospitals employ medical billing and coding teams to handle everyday billing.
The process of physician billing is complicated and detailed. It is also time-consuming and requires a lot of effort and time. Scribe Align makes it easy by connecting healthcare providers with hospitals and insurance companies so they can focus on patient care instead of insurance claim submission. By outsourcing the billing process to a healthcare billing service provider like Scribe Align, you can focus on the doctors practice and patient care instead of worrying about getting paid for the medical services.

Hospital billing: What is it?

•    The hospital or healthcare provider submits claims for inpatient and outpatient services in hospital billing. For the same reason, hospital billing can also refer to institutional billing.
•    A hospital billing system also accounts for the services provided by skilled nurses. They also bill claims for medical facilities and medical claims for laboratory services, medical equipment, radiology, supplies, etc.
•    An institutions configuration is indicated by I. Hospital billing is performed using forms UB-04 or 837-I. In contrast, the UB-04 is a paper-based form, while the 837-I is a computer-based form.
•    A physicians billing is similar to a hospitals billing, except that hospital billing only deals with the medical billing process; it does not deal with medical coding. However, physician billing also includes medical coding.
•    The hospitals appointed medical biller is only responsible for billing and collection in hospitals. It is challenging to handle hospital billing as compared with physician billing.


Billing for Physicians and Hospitals: how to increase revenue?

•    Hospitals and physicians have different billing models when it comes to revenue reimbursements. But their processes have a significant impact on preventing denials and fraud.
•    Keeping track of unbilled and unmissed claims and services becomes the physician billers priority. However, the staff should be aware of any billing or coding errors when submitting claims. Technical errors can also cause mistakes for various reasons.
•    Outsourcing healthcare billing and coding services is often the best option for hospitals and healthcare providers to avoid errors and payment losses.
•    The hospital billing process is quite different from physician billing. A hospital or institutions billing function includes collection and billing.
•    As a result, institutional cases are handled only by coding experts because hospital coding is considered more complex than physician coding.

It is essential to avoid violating HIPAA privacy and security rules since physicians and hospital billing staff have access to private and confidential patient health information.
Thank you for reading about Physician Billing and Hospital billing. I am pleased to provide you with information on physician and hospital billing.

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