The Importance of Being HIPAA Compliant

HIPAA compliance isn't a very difficult concept to comprehend. Basically, you don't share a patient's medical information with anyone that isn't the patient or has been designated by the patient. Examples of HIPAA compliance in a medical office include physical patient files that are kept under lock and key, away from unauthorized persons and electronic files that are only assessable by password. Compliance in a reception setting can be having a conversation behind closed doors instead of at the front desk or flipping a patient's chart over to maintain anonymity. Any facility found to be uncompliant, either unknowingly or knowingly, face several levels of consequences leading up to imprisonment and loss of licensure. (Better Credit Today, 2017; Edwards, 2017); Go Telecare, 2017; HIPAA Journal, 2017; Indiana University, 2017; MB Guide, 2017). "In recent years, the federal government has made it harder for a medical provider to simply ruin your credit" (Better Credit Today, 2017). This being said, medical billers have to be cautious when releasing the necessary information on a patient's debt.

If information regarding a patient's health history were to be released to a collection agency and the patient were able to prove that the information was in violation of their HIPAA rights, a lawsuit can result. The only information that should be released to a debt collector is the amount of the bill and who it needs to be paid to. This should only happen after the established billing cycles has been reached without payment from a patient. (Better Credit Today, 2017; Edwards, 2017); Go Telecare, 2017; HIPAA Journal, 2017; Indiana University, 2017; MB Guide, 2017). Consequences for not maintaining compliance with HIPAA could result in severe penalties and courses of action that are better left unexperienced. This means civil and criminal penalties. Consequences are tiered into four categories and each category has its own separate penalty. Category 1 states that the violator was unaware of and could not avoid making the violation. This carries with it a $100 to $50,000 fine per violation. Category 2 states that the violator should have noticed the violation but that neglect was not an action of violation. This category carries a penalty of $1,000 per violation and up to $50,000. Category 3 is when a violator made an attempt to correct their mistake, but the mistake was not corrected. This results in $10,000 to $50,000 in fines, per violation.

Category 4 is willful neglect with absolutely no attempt at correcting this violation. The fine for this category begins at $50,000 per violation. (Better Credit Today, 2017; Edwards, 2017); Go Telecare, 2017; HIPAA Journal, 2017; Indiana University, 2017; MB Guide, 2017). "It is up to OCR to determine a financial penalty within the appropriate range" (HIPPA Journal, 2017). OCR is the Office of Civil Rights and is run by the Department of Health and Human Services. The above listed penalties are only for civil violations. Criminal charges include jail time from a minimum of one year up to ten years along with fines to be paid. (Better Credit Today, 2017; Edwards, 2017); Go Telecare, 2017; HIPAA Journal, 2017; Indiana University, 2017; MB Guide, 2017). A patient's billing information is not protected under HIPAA guidelines; therefore it is not a violation for the information to be shared with a collection agency. As protected as one's medical information is, the information regarding the medical debt is not protected. What's more, it is not required to notify a debtor of a debt being sent to collections. (Better Credit Today, 2017; Edwards, 2017); Go Telecare, 2017; HIPAA Journal, 2017; Indiana University, 2017; MB Guide, 2017).

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Overall, a good medical biller will know what information is and is not allowed to be disclosed in sending a delinquent account to collections. From a patient's appointment with the provider to sending a patient's account to collections, a medical biller should be fastidious and observant to all the information that is being shared and processed to ensure that only what is needed is provided. Failure to adhere to HIPAA rules and regulations can result in legal action on different levels. Not only for the person who violates a patient's rights, but also for the facility a biller is employed by. (Better Credit Today, 2017; Edwards, 2017); Go Telecare, 2017; HIPAA Journal, 2017; Indiana University, 2017; MB Guide, 2017).

References

1. Better Credit Today. (2017). Unpaid Medical Bills. https://carreonandassociates.com/hippa-collections/
2. Edwards, T. (2017). Collection Agencies & HIPAA Laws. https://legalbeagle.com/5679447-collection-agencies-hipaa-laws.html
3. Go Telecare. (2016). The Importance of HIPAA Compliance in Medical Billing.https://www.gotelecare.com/hipaa-compliance-in-medical-billing/
   HIPAA Journal. (2017).
4. What are the Penalties for HIPAA Violations? https://www.hipaajournal.com/what-are-the-penalties-for-hipaa-violations-7096/
   Indiana University. (2017). What are the penalties for violating HIPAA?.
5. https://kb.iu.edu/d/ayzfMB-Guide. (2017). The Most Important Medical Billing Laws. http://www.mb-
   guide.org/medical-billing-laws.html

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