What
is HIPAA?

The Health Insurance
Portability and Accountability Act (HIPAA) is a legislation proposed by U.S.
Congress in 1996 that was proposed to provide the data privacy and security
provisions to safeguard the medical information from the intruder. It strictly
protects the health information and implements policies and procedures to
safeguard it in both paper and/or electronic format. We believe that our medical
and other health information is private and is highly protected, and we want to
know who has this information, the confidentiality is protected. HIPAA gives
rights to the individual over their health information and sets rules and
limits against those information on who can look at and receive health
information. HIPAA applies to all forms of individuals’ protected health
information whether it is in electronic, written, or oral format. Health
insurance companies, Health Management Organization, health plans company,
government programs, and Health care providers must follow the HIPAA
regulations during transmission of Health information. There is HIPAA privacy
rule as well as HIPAA security rule which is a subset of HIPAA privacy rule
that protect the health information that are electronically transmitted. HIPAA
security rule is highly technical whose purpose is to make sure certain
technologies follow the best practices.

HIPAA
in Medical Billing

Parkview Health System,
Inc. which is a nonprofit health care system that provides health care services
to individuals in U.S is tied up with the agreement to settle potential
violations of HIPAA. This violation includes any complaint from a retiring
physician alleging that Parkview had violated the HIPAA Privacy Rule. The
violation happens due to leaving medical records unattended that were
accessible to unauthorized persons that break the rule to protect the personal
health information to ineligible candidate. Negligence is happening everywhere
with lot of people frequently that causes the breaches in the privacy of
patient’s medical record and data security violations. Most of the people think
that the negligence can happen by an accident and will not bring big issues to
the data privacy, but in fact negligence can bring intruder to take over the
secured data of an organization. This is not only one violation case, there are
all kinds of HIPAA violation cases out there – whether they violate the
security, administrative or technical safeguards, data breaches often occur
within certain parameters. This violation can happen in many factors like
mailing one patient’s bill to unknown or previous address, emailing the record
to unidentified email address, passing medication information to third person
and many more. These violations occur due to unencrypted of their personal
data, employee negligence/error, data stored in unsecure devices, Business
associates, and notifications sent to wrong person (What is a HIPAA Violation?,
2016).

.

How
HIPAA Makes Medical Billing Secure

 

There are different
legislative workings at this period for the protection of Personally Identified
Information (PII). There is not a dedicated patient’s medical data protection
law right now, but instead regulates primarily by industry on a
sector-by-sector basis. There are numerous sources of privacy law that are
acting in both the federal and state levels like FCRA (Fair Credit Reporting
Act), FACTA (Fair an Accurate Credit Transactions Act), COPPA (Children’s
Online Privacy Protection Act), DPPA (Driver’s Privacy Protection), VPPA (Video
Privacy Protection Act), HIPAA (Health Insurance Portability and Accountability
Act). These sources ensure that the personal/organizational information
captured must be secured and should not be disclosed in the marker
otherwise/unless authorized by the users. These organizations/firms ensure the
Confidentiality of the data by making sure the data goes to the person to whom
it belongs, Integrity of the date by making sure the data does not alter during
the transformation, and Availability of that data by making sure that the data
is available when it is needed. The CIA protect against any upcoming and anticipate
threats to the security or integrity, protect against disclosure, and many
more.

There is a huge challenge
to the country about the Health care system that spends too much on
administrative processes. Tremendous amount of money almost over $1.3 trillion
is spent per year in health care which is higher than 1/8th of US
economy and close to 14% of GDP where on the other hand other industrialized
nations spend almost 7% of GDP. From 15% – 30% goes to administration due to
lack of e-commerce and electronic exchange of information that can be both
personal and governmental, poorer quality of care, and more fragmented system.
Its objective is to reduce the amount of risk that might occur intentionally or
accidentally disclosing the information or misuse of the information, or the
loss or corruption of patient-identifiable information due to outdated system by
protecting and enhancing the rights of consumers giving them proper access to
their health information as well as controlling the appropriate use of that
information from the intruder. The Act improves to the efficiency and
effectiveness of healthcare information either in electronic format or paper
format by creating a national framework for health care privacy protection act
that builds on efforts by states, health systems, individual organizations and
the individual.

HIPAA
Transaction Format

            Provider must protect all
individually identifiable health information, regardless of the method in which
the data is maintained or transmitted (paper, electronic, oral) and comply with
national standards when conducting the named transactions electronically with a
covered health plan. Any transaction both in electronic format as well as paper
format standardized under HIPAA conducted by a provider must be done in the
HIPAA format. Some health plans may require, under contractual agreements,
providers conduct any transactions with them electronically must follow the
HIPAA format.  However, this is not a
HIPAA requirement, rather, it is a business decision.  Contact your payers, clearinghouse, or
billing service to discuss their HIPAA plans.