5 Things Every Medical Billing Specialist Needs to Know about Privacy Laws

As a medical billing specialist, you are responsible for handling very sensitive and private patient, medical facility, insurance and physician records. It is not only good business practice to do everything within your power to protect this information, but it is also the law. Government regulations have a tight grip on medical billing procedures, in the form of the Health Insurance Portability and Accountability Act (HIPAA), and what you don’t know can hurt you as a professional. Here are five things every medical billing specialist needs to know about privacy laws:

Who HIPAA covers. All health care providers (doctors, hospitals, laboratories, clinics, pharmacists, mental health professionals, dentists, etc.), health plans (health insurance providers, Medicaid/Medicare, HMOs, etc.), and health care clearinghouses are subject to the provisions of HIPAA. As a medical billing specialist, you are a health care clearinghouse, and are therefore bound by the full extent of the HIPAA regulations.

What HIPAA covers. Under HIPAA law, every past, present and future record of medical care, including payment for that care, is covered by HIPAA for as long as the information is held by a health care provider, health plan, or health care clearinghouse.

Protected Health Information (PHI). This is any information that is relayed by a covered entity, whether it is shared on paper, electronically, or by mouth. For example, your conversation with a patient about that patient’s address change is actually considered PHI, and it is your responsibility to handle that information according to HIPAA standards.

“Minimum Necessary” Standard. This Privacy Rule holds that medical professionals are to share the very minimum amount of medical information as is required by the circumstances at hand. For example, if an insurance company requests that you, a medical biller, provide them with patient information, you can only legally provide information that directly relates to the insurance company’s role in working with that patient.

HIPAA Code Sets. HIPAA has identified code sets that are to be used by all medical billing professionals in order to streamline the electronic filing of medical records. There are also Code Set Rules outlined by HIPAA, which provide guidelines for protecting information that is passed electronically to and from medical billing offices and other HIPAA-covered entities.

Being a medical billing professional, whether you work directly for a hospital or find work through finance recruitment companies, requires that you adhere to some very strict rules and procedures when it comes to the medical information you are charged with handling. Protect yourself and the patients whose medical records you process by learning the ins and outs of HIPAA law, and by keeping these basics in mind.

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