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Posts from 2018-10

Everything You Need to Know About HIPAA Compliance

Being HIPAA complaint is very important. Read on to learn everything you need to know about HIPAA compliance.

Keyword(s): hipaa compliance

What's a physicians least favorite animal? A Hippo, since it's only one letter away from Hippa!

You can have that joke for free, as a bonus to this article. Consumers love HIPPA since it makes it easier to get personalized and sometimes secret care. However, it can create a lot of problems for practitioners and their staff, if they don't follow the regulations.

Correct HIPPA compliance is essential to any functioning clinic. But how long do you take to tell each new employee what it is and how to follow it?

Sometimes it takes weeks. That legal language is hard to wrap your head around. Instead of trying to translate - read our guide instead.

What is HIPPA?

The five letter acronym stands for the Health Insurance Portability and Accountability Act. It came to be in 1996, but we didn't hear it really talked about until the mid-2000's with the passing of Obamacare.

Its purpose is to protect patients from having their information and health history spread. It protects specific patients from being mentioned in research or papers. If Suzy Q had an interesting reaction to a hysterectomy and her doctor wanted to do a study on it, her name would be patient x.

Or something of the like.

Why Have HIPPA?

Before they put HIPPA into place, almost every health care network had their own processes for claims. HIPPA changes that by making everyone use the same system.

It's like if some clinics in the states were using the metric system while others used imperial. If an imperial clinic had to send records to a metric, that would be a pain. So now, everyone is on the HIPPA system.

It also came from some security breaches of patient confidentiality in the 90's. Along with that, the legislators behind Obamacare knew there would have to be some stricter regulations with a government controlled system.

What Does it Change?

Other than giving everyone the same system, HIPPA changes what different people at different points of the medical process see. If the doctor needs to share information with another doctor, they can see the patient's whole file.

However, if billing is processing a treatment the patient had, they only have enough information to get the job done. That may just mean name, age, a treatment code, and insurance information.

It puts regulations and restrictions on the number of eyes that can see sensitive details of a patients file.

What Must I Change?

Most of us are already familiar with HIPPA compliance, which means we avoid the use of certain "unique identifiers" when discussing patient history. Unique identifiers are anything that could give someone the true identity of the patient in question.

Here's a comprehensive list of all the HIPPA identifiers.

  • Name
  • Address (smaller than state)
  • Telephone number
  • Fax number
  • Email address
  • Medical record number
  • Serial numbers of any device (medical or other)
  • Images of the patient
  • Account number
  • Social security number
  • Health plan number
  • Fingerprint or other biological identifiers
  • IP address
  • Personal websites
  • Anything else that separates patient A from patient B in identity or personality.

Let's look at an example. Say you were doing an experiment on two patients for a medication.

A HIPPA friendly report wouldn't have any identifiers. So the following information could not go anywhere until the identifiers are removed.

Information with identifiers:

We are studying the effects of medication A on two patients, Thomas and Andrew. Both patients agreed to take the medication for a reduced cost in exchange for follow up appointments.

The appointments are every Wednesday from 3-5 PM at the patient's home hospital, ABC hospital. Patient Thomas has a heart pump, serial number, 3234234.

See how much information is in that about Thomas and Andrew? Here's what that information looks like as HIPPA compliant.

Two patients agreed to test the side effects of Medication A at ABC hospital. They are receiving reduced cost in exchange for follow up appointments and research tests. One patient has a heart pump, which is a potential extraneous variable to track.

Patients check in once, weekly, for two hours to talk to researchers and run tests.

See the difference?

You still understand the purpose of the experiment and what's going on without identifiers. That way both Thomas and Andrews's identities stay safe and they can go on with their lives.

HIPPA After Death

One a patient dies, they're still protected by HIPPA regulations. As the law stands now, their records need to stay compliant for fifty years from the day they died.

There are some cases where identifiers of the deceased can be shared, but it required approval by family or specific doctors.

HIPPA Exceptions

Finally, there is one situation where you can share the identifiers of a person. If the patient gives you reasonable reason to believe they're going to hurt themselves or others, the doctor is allowed to share that information for prevention.

This could be to parents, law enforcement, or social workers. Doctors do need to tell patients that they're required to report this information, which is part of the reason we require HIPPA consent forms.

Maintaining HIPPA Compliance Practices

The information covered in this article as identifiers can also be referred to as PIH, or private health information. The same PIH apply to all sectors of medicine, dental offices, and the like.

If you handle health information and records, you're required to work with Hippa compliance. If you're not, your clinic could be fined large amounts, sued, or even shut down completely.

That's not something you can risk. Make sure you use our billing services and programs - we build our compliance in. Check it out here.

Common Medical Billing Mistakes to Avoid

Doctor Pointing at Tablet Laptop Running a successful medical practice comes with its own set of challenges. New practitioners have to overcome a large learning curve when it comes to the dos and don'ts of starting their own business for the first time.   

In addition to all of this, it is common for health care professionals to make mistakes when it comes to their medical billing process.

Unfortunately, these mistakes can cost their practice dearly when it comes to revenue and their bottom line. To assist practitioners in avoiding these costly errors, we have compiled a list of some of the most common medical billing mistakes.

By taking note of this list, your practice can improve its chances of increasing revenues and building a solid foundation for success.   

Unbundling Codes 

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Often times, there is one code that can successfully capture payment for multiple parts of a medical procedure. Sometimes health care professionals incorrectly use multiple CPT codes for various parts of a single procedure, when it is this single code that should be used for everything.   

Medical practices that unbundle their codes can do so out of a lack of understanding or in an attempt to increase their bill on purpose and fraudulently. To learn more about unbundling and how to avoid it, contact a medical billing service provider.    


When health care professionals incorrectly change billing codes so they show a more serious diagnosis or service, "upcoding" occurs. Upcoding is highly illegal and falsely inflates patient bills. For example, if a practice meets with a patient for only 15 minutes but charges them for a full 45-minute session, this would be upcoding.   

Other frequent upcoding violations include things like listing a name brand medication when a generic brand was actually the one used or stating a normal office visit was a more specialized one.   

Consequences of upcoding can be quite serious, as practitioners can be fined hundreds of thousands of dollars or even be excluded from participating in various medical programs.   

Billing Multiple Times for the Same Service  

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Double or triple billing can occur when different members of a practice charge a patient for the same thing. For example, medication could be billed at both the time of prescription either on purpose or unintentionally. Sometimes hospitals also bill patients for the first few days of their stay, multiple times.   

This happens because the first few days of a hospital visit often cost more than days later in the visit. Multiple billing is one of the biggest reasons behind high medical bills.  

Be sure to keep an eye out for potential situations within your practice that could be vulnerable to multiple billing. Setting some safeguards to prevent this from happening can make a big difference.   

Mistakes in Patient Information  

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If your practice makes any mistakes in listing a patient's information, insurance companies can easily reject your claim. Errors in medical billing are pretty common thanks to the fact that medical bills come under contact with so many different people at a time.  

Mistakes can fall through people's fingers and be passed down to the next individual in charge. Enforcing safeguards when processing patient information is key to avoiding additional mistakes that could affect your claims.   

There just a few of the most common billing mistakes healthcare providers make. By becoming familiar with these frequently occurring errors, medical practitioners can get their new businesses off to a strong start.  

Take the time to set some safeguards so your practice doesn't get sued or fined by different medical organizations. It only takes a few mistakes to lose the trust of your patient base or get fined so much money that your practice has to shut down.   

To learn more about how you can prevent medical billing mistakes, contact us by clicking here

The Future of Medical Billing - Trends & Integrations

Woman Holding Pen While Using Calculator  

By now it's clear that populations around the world will continue to spend more money on health care as years go by. Unfortunately, many healthcare organizations will see their operational costs rise along with this increased spending within their industry.  

Medical billing complexities are no help to these providers, as coding continues to grow more intricate. Thousands of unique codes exist for different medical systems, procedures, and situations. These codes will always change and evolve with the industry.   

Thankfully, the medical billing and coding industry is moving towards increased efficiency and effectiveness. Here are some of the latest innovations and trends helping move the industry in the right direction:  

Blockchain Technology

  Black Laptop Beside Audio Mixer Set  

Blockchain technology has been showing really interesting possibilities for the future of Electronic Health Records (EHR). The innovative ways in which blockchain functions has pushed it as an increasingly common way to improve the security and standardization of healthcare data.    Many have touted blockchain as the next big innovation in healthcare technology.

In fact, blockchain technology could potentially transform the very nature of EHRs.   Here are a few reasons EHRs should consider implementing blockchain data storage:

  • Much better privacy protections
  • To make information exchange easier and more efficient
  • To increase patient control over their data

There is also tremendous potential for how blockchain could potentially improve revenue cycle management and claims processing for healthcare providers across the world.  Blockchain would give providers the ability to record tests, results, medical billing, and payments in an unchangeable register. 

This change alone could help practitioners reduce fraud and potentially save money by reducing the amount of time, energy, and money currently used to track this type of information through different systems.   

Computer Assisted Coding (CAC)

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Computer-assisted coding is currently growing rapidly, especially when it comes to coding inpatient claims. In fact, reports indicate the global market for CAC software could reach $4.75 billion by 2022. Some healthcare professionals are concerned that this new technology could take jobs and replace many industry workers within the next ten years.

However, it is important to realize that computer-assisted coding software works best as an aid to human workers.    According to a recent study, CAC helped increase coder productivity by over 20% and lowered coding time by 22% relative to those who didn’t use CAC, all without reducing accuracy. On the other hand, CAC software is actually less accurate when used without the help of a professional human coder.   

Aligning EHR 

Unfortunately, inaccuracies in record keeping can lead to a mountain of problems when it comes to getting reimbursed. Most medical practices spend a tremendous amount of time searching for the right diagnostic codes instead of getting to know their patients better. Thankfully there are ways to improve the effectiveness of your record keeping activities.

Finding ways to integrate technologies can be a great way to do so. For example, there are so many benefits to aligning your EHR and medical billing software. Furthermore, if your medical billing offers CAC, the process can go even faster.  These integrations can make it possible for automated coding suggestions to pop up at the point of documentation, helping make codes more accurate right from the beginning.

Your practice could also auto-populate patient data into billing documents, helping save your staff valuable time and potential errors.  Integrations such as these can helphealthcaree providers reduce errors, save time and provide more in depth reports than traditional EHR and billing methods of the past. 


For more information on medical billing & coding innovations, please contact us by clicking here!