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Ensuring Privacy in Medical Billing 2020-03-21T13:23:26+00:00

Ensuring Privacy in Medical Billing

medical privacy at the officeA large portion of a medical billing specialist’s responsibility is to communicate with the healthcare provider regarding exact details of services rendered. There are federal and state healthcare laws with which medical billing and coding specialists must adhere to ensure the privacy of each patient. Medical billing specialists are responsible for facilitating electronically and/ or physically the transfer of sensitive medical information between relevant parties (i.e. patients, insurance companies, healthcare professionals…etc.). Failing to adhere to the guidelines and preform duties within the parameters of state and federal healthcare laws can result in a federal investigation. 

HIPAA Compliance

The Health Insurance Portability and Accountability Act of 1996, HIPAA, was passed by Congress and signed into law by President Clinton. HIPAA provides universal security provisions and data privacy to ensure the safety, security, and privacy of a patient’s medical information. Every billing specialist is required to remain HIPAA compliant while billing. While HIPAA is split into five sections, known as Titles, Title I and Title II include the applicable duties for medical billing and coding, in relation to HIPAA. 

    • Title I: Healthcare Access, Portability, and Renewability: This section of HIPAA outlines health insurance policies within the confines of an individual’s employment. Title I ensures that more people are eligible for health insurance, raising the number of potential healthcare visits as well as frequency of visits. This increases the number of claims for which medical billing departments are responsible.


  • Title II: Preventing Medical Healthcare Fraud and Abuse, Administrative Simplification, and Medical Liability Reform: This section of HIPAA focuses on many relevant aspects in relation to medical billing and coding. The primary aspects being the security and privacy requirements in relation to handling a patient’s medical records. 


Privacy Rule and Security Rule

Title II establishes additional privacy measures as outlined in the Privacy Rule and Security Rule. The Privacy Rule: addresses how providers and insurance companies are meant to handle patient information by regulating how they disclose the information to each other as well as any other covered entities that may require medical data. As per Title II, billing and coding specialists are not allowed to share a patient’s Protected Health Information (PHI) with parties that are not covered entities. According to HIPAA, a patient’s PHI includes the following:

  • A patient’s medical record, including past and present medical illnesses, conditions, and treatments
  • Fees paid by a patient and/ or a patient’s medical insurance company used to cover healthcare expenses rendered by a healthcare provider
  • The location where the patient received care
  • The type of healthcare provider seen by the patient

The Security Rule was created with the intention of protecting a person’s information outlining various rules and also details how those rules can be enforced, if needed. This rule describes how covered entities must collaborate with one another in order to properly protect a patient’s medical information. This rule includes the computerized physician order entry (CPOE) systems as well as electronic healthcare records (EHRs) that are used daily by medical billing and coding specialists. HIPAA also requires any technologies used by medical billing departments to transfer a patient’s medical information between covered entities to be secure and up to the established standards of HIPAA.

Further Information

As insurance regulations change, it is imperative that companies understand how each change can affect their practice, in all aspects. Insurance companies are notorious for offering excuses and utilizing loopholes to avoid paying providers what they owe. Accreditations such as CARF and JCAHO are now a common requirement for insurance companies to render payment. These certifications alert the public that a company has been adequately inspected and is considered reputable, meeting the accreditations high standards. The accreditation process can be arduous, requiring a significant amount of time and energy. Our staff offers diverse skills that enable Oracle Billing and Services, Inc. to assist in areas ranging from CARF-Accreditation, Verification of Insurance benefits, Insurance Collection Calls, Drug/Alcohol state licensing, JCAHO-Certification and more. Oracle Billing and Services has extensive experience in assisting companies in the health industry, in understanding the ever-changing regulations as well as providing expert consultation for all areas of operations.

Further Reading

Help Resolving Claim Disputes for Medical Billing

Finding a Medical Billing Company For Your Practice

Medical Billing for Rehabs

Ensuring Privacy in Medical Billing

The Cost of In-House Medical Billing vs. an Outside Agency