There should not be any compromise on HIPAA Compliance. Now, when most medical facilities outsource medical billing services, the responsibility to collect, store, and protect data from malicious threats or misuse falls onto their shoulders!
Of course, there must be some measures and prerequisites in place to avoid any haphazard. But, when you’re not aware of the sensitivity of the issue, how can you think of a plan that covers every aspect.
Introduction of HIPAA Compliance
Health Information is sacred in the healthcare industry, it’s the same as a secret formula, which can’t be disclosed publically or at least without the authorized person’s permission. That’s why the U.S. Department of Health and Human Services (HHS) developed regulations and rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to protect confidential healthcare information. These are known as the HIPAA Privacy Rule and the HIPAA Security Rule.
The Privacy Rule or Standards for Privacy of Individually Identifiable Health Information suggests national guidelines to protect health information. Whereas the Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) addressed technical and non-technical measures that every healthcare organization and medical billing company must deploy to ensure the security of Electronic Protected Health Information (e-PHI).
Even HHS has a subsidiary as the Office for Civil Rights (OCR) that guards the voluntary compliance activities and penalties to enforce Privacy and Security.
Entities Covered by the Security Rule
The Security Rule applies to the entities of health plans, healthcare clearinghouses, and to any healthcare provider who transmits health information digitally in connection with a transaction for which the Secretary of HHS has adopted standards under HIPAA and to their business associates. (Source: HHS)
What Information is to be Protected?
Electronic Protected Health Information refers to the information that needs to be protected and is used to identify an individual. The security rules also defend a subset of the Privacy Rule Information that includes all individually identified health information that any stakeholder creates, receives, collects, maintains, or transmits via electronic medium.
However, medical billing services should know that the Security Rule does not apply to the information transmitted orally or in written format.
General Rules to Abide By Business Entities
The Security Rule encourages covered entities to embed reasonable technical, physical, and administrative safeguards to maintain the confidentiality of the e-PHI.
Entities including healthcare professionals, payers, and particularly medical billing services should:
Guarantee the confidentiality, integrity, and availability of all Electronic Protected Health Information that they create, receive, maintain, or transmit.
- Identify security loopholes and protect against threats to the database.
- Protect against potential threats or anticipated or impermissible uses or disclosures of data.
- Enable system or framework in the company to ensure compliance.
Here confidentiality refers to that no information is disclosed to any unauthorized person. The Security Rule also supports Privacy Rule Prohibitions against improper use of information along with two other objectives as Integrity and Availability of e-PHI.
The integrity of e-PHI means no information is altered or distorted in an unauthorized manner.
The availability of e-PHI means information is easily accessible or usable at the request of an authorized person.
Security Rule is Flexible
Security Rule is flexible to consider the infrastructure of the healthcare organization of every size from small to medium to large, to hybrid parties. Therefore, it is in the law to respond appropriately to the size and requirements of the medical practice.
HIPAA Security Rule never dictates the measures but encourages considering the following aspects of the practice.
- The possible impact of potential risks to e-PHI
- Total budget dedicated to security measures
- Size of medical practice, complexity of the system, and capabilities
- Technical, hardware, and software infrastructure of the healthcare organization
Risk analysis management, administrative safeguards, and other aspects of the company also have to take into consideration to maintain the quality of data transmission.
Under HIPAA rules, the administrative safeguards refer to the policies and procedures that manage, select, implement, deploy, and maintain the security safeguards for electronic health information. Moreover, it also involves measures for the secure conduct of the covered entity workforce.
It is to note that professional medical billing services train their coders and billers as per the industry updates. It also comes under administrative measures to protect patients’ information.
It refers to the physical access and electronic equipment where medical information resides. Medical billing companies must protect systems by implementing physical safeguards to restrict unauthorized access.
HIPAA rules say to implement technology to strengthen physical barriers against theft and fraudulent activities. However, it is not a compulsion, but physical safeguards must be in place to secure information.
Technical safeguards refer to the technology incorporation for the protection of electronic health records (EHRs). The policies for technology use also come under the banner of technical safeguards.
If a medical practice or a medical billing company is HIPAA-compliant, it must ensure physical, technical, and administrative security measures. Besides, one of the reasons for outsourcing medical billing services is to ensure the quality of security outcomes. Because generally, healthcare organizations are unable to upgrade security measures as per the HIPAA updates.
Healthcare information, specific to any individual or organization, or health plan, is strictly prohibited and non-ethical to share for unofficial use. When a patient comes in contact with any medical facility, he expects to stay confidential. The government also protects his/her rights of privacy, and therefore, as physicians and medical billers, and coders, we can’t force them to share information, which is not meant to be.