How are HIPAA and Medical Billing Associated?

For most of us, the extent of our experience with HIPAA and medical billing is from when we visit a physician or have a procedure performed at a hospital. From a patient’s perspective, the main purpose of HIPAA is to prevent anyone from abusing our personal health information. That may explain why we are starting to see HIPAA related to medical billing and medical debt collection more and more. The fact is that HIPAA is more far reaching than most of us know, and it can help us when we are faced with a medical debt collection.

What is HIPAA?

HIPAA is an acronym for the Health Insurance and Portability and Accountability Act, which President Clinton signed into law in 1996. While it serves many different purposes related to healthcare in the United States, its primary goal is to modernize the ever-increasing flow of healthcare information. It also aims to prevent fraud and identity theft, as well as limitations on healthcare coverage. Most people’s experience with HIPAA extends to the paperwork they fill out at the doctor’s office limiting who has access to their medical information.

HIPAA and Medical Billing

As we’ve stated, HIPAA’s major role is medical privacy, though it does govern many issues beyond that. In terms of medical billing, HIPAA establishes standards for electronic medical transactions which include:
  • Diagnosis codes
  • Treatment codes
  • Transaction codes
  • Specific billing formats
  • Insurance claims formats
While it sounds confusing, the goal of all these standards and formats is to simplify the process of medical billing and insurance claims by streamlining the flow of information across entities such as:
  • Medical clinics
  • Hospitals
  • Emergency rooms
  • Insurance companies

HIPAA and Privacy

As far as privacy goes, HIPAA has requirements that medical providers and their offices must follow in order to safeguard health information, having an indirect impact on billing. These requirements ensure that our private health information is protected and not used inappropriately, and it also establishes how providers can legally use patients’ health information.patient and doctor

If a medical provider is in violation of HIPAA regulations, or a breach occurs that exposes personally identifiable medical information, there are serious consequences including fines and lawsuits. This aspect of HIPAA also impacts medical billing because of the transfer of sensitive, personally identifiable health and financial information to other parties.

Breaches and Non-Compliance

If an entity is not compliant with HIPAA regulations, the company will undoubtedly face fines and some type of punishment. What is worse than non-compliance, however, is a data breach. A data breach occurs when personally identifiable health information is accessed and/or used by an unauthorized person or through non-compliance. Data breaches are a very serious matter and result in long and costly lawsuits, as well as expensive forensic investigations, notification of all who are affected, remediation to those affected, and more.

HIPAA and Collection Agencies

HIPAA regulations affect collection agencies if they are dealing with medical debt. They must sign a HIPAA Business Associate Agreement to indicate they will comply with HIPAA regulations that involve protected health information. In order to collect a medical debt, collection agencies do not need detailed information about your health and medical history unless it is directly involved with the debt they are trying to collect.

HIPAA information privacy Collection agencies are also responsible for making sure that any protected health information they do receive is secured from unauthorized access. The office or clinic that turns a medical debt over to a collection agency is responsible for making sure they only provide the minimum amount of information needed to collect the debt.

If you believe that the collection agency that is trying to collect your medical debt has too much of your personal health information, you will likely be able to use this as a negotiating point. Through the threat of a lawsuit for HIPAA violations, you can convince a collection agency to delete your bill after you have paid it, rather than just marking it a paid debt. Keep in mind that a paid collection will still count against your credit score, but a deleted bill will not.

Beyond The Flow of Information

HIPAA’s purpose goes beyond limiting who can access your test results from the doctor’s office. Its original goal is to simplify and modernize the flow of medical information. Part of that involves protecting your personal health information and making sure it is only accessed by those with a legitimate need for it. When viewed that way, it is easy to see why it is important to have HIPAA and medical billing – and medical debt collection – closely aligned. Debt collectors must also abide by HIPAA regulations to ensure that no unauthorized person or entity has access to your private information.

Health Care Advocate Fighting to Lower Your Medical Bills

At Consumer Medical Bill Solutions, we specialize in helping you get your medical debt down to a manageable level by aggressively negotiating on your behalf with billing services and debt collection agencies. Before we can start negotiating for you, you must sign HIPAA paperwork releasing the necessary information to us. Once we have the information we need, we can often achieve a savings of up to 40% on the medical debt you owe. If you have medical bills that seem to just keep piling up and you don’t know where to begin, start by contacting us at Consumer Medical Bill Solutions!