{"id":288,"date":"2021-12-26T03:52:58","date_gmt":"2021-12-26T03:52:58","guid":{"rendered":"https:\/\/atlanticrcm.com\/blog\/?p=288"},"modified":"2021-12-19T03:58:44","modified_gmt":"2021-12-19T03:58:44","slug":"significance-of-hipaa-compliance-in-medical-billing","status":"publish","type":"post","link":"https:\/\/atlanticrcm.com\/blog\/significance-of-hipaa-compliance-in-medical-billing\/","title":{"rendered":"Significance of HIPAA Compliance in Medical billing"},"content":{"rendered":"<p>Data breach costs the healthcare industry around $7.13 million every year in the US. Smart technology can reduce breach costs by half, but only 23% of healthcare companies have fully deployed such security tools. Malicious attacks account for 50% of the data breaches. Human error and system glitches account for 27% and 23% respectively, per recent analyst reports.<\/p>\n<p>The Health Insurance Portability and Accountability Act (<a href=\"https:\/\/atlanticrcm.com\/blog\/exhibiting-hipaa-compliance-is-vital-in-email-correspondence\/\">HIPAA<\/a>) was introduced in 1996 with two goals in mind:<\/p>\n<ol>\n<li>Prevent healthcare fraud, appropriate security to health data, and restrict access only to authorized individuals, and<\/li>\n<li>Ensure health insurance coverage for individuals that are in between jobs<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-289\" src=\"https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/12\/HIPAA-Compliance-1.jpg\" alt=\"HIPAA Compliance \" width=\"899\" height=\"600\" srcset=\"https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/12\/HIPAA-Compliance-1.jpg 899w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/12\/HIPAA-Compliance-1-300x200.jpg 300w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/12\/HIPAA-Compliance-1-768x513.jpg 768w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/12\/HIPAA-Compliance-1-219x146.jpg 219w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/12\/HIPAA-Compliance-1-50x33.jpg 50w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/12\/HIPAA-Compliance-1-112x75.jpg 112w\" sizes=\"auto, (max-width: 899px) 100vw, 899px\" \/><\/p>\n<p>Complying with HIPAA the healthcare industry can reap many benefits, like:<\/p>\n<ul>\n<li>Streamline administrative functions<\/li>\n<li>Improve operational efficiency<\/li>\n<li>Data security and privacy for health information<\/li>\n<li>Standards for health data recording, and transactions keeping stakeholders on the same page<\/li>\n<li>Ease health information transmission between providers, payers, and other entities<\/li>\n<li>Ease of access to information for review, and seeking treatment from new healthcare providers<\/li>\n<\/ul>\n<p><strong>The covered entities<\/strong>: HIPAA compliance is mandatory for all healthcare entities comprising providers, payers, clearinghouses, and business associates.<\/p>\n<p><strong>Non-compliance and penalties:<\/strong><\/p>\n<p>A non-compliance is a deliberate or unintentional violation of the\u00a0<strong>HIPAA Breach Notification Rule<\/strong>. Non-compliance is resolved by issuing technical guidance, but serious violations attract financial penalties as in the table below.<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"53\"><strong>Tier<\/strong><\/td>\n<td width=\"382\"><strong>Violation Type<\/strong><\/td>\n<td width=\"69\"><strong>Minimum Fine per Violation<\/strong><\/td>\n<td width=\"71\"><strong>Maximum Fine per Violation<\/strong><\/td>\n<td width=\"75\"><strong>Maximum Fine per Year<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"53\">Tier 1<\/td>\n<td width=\"382\">Unaware of HIPAA violation and with reasonable due diligence would not have known HIPAA Rules violation<\/td>\n<td width=\"69\">$100<\/td>\n<td width=\"71\">$50,000<\/td>\n<td width=\"75\">$25,000<\/td>\n<\/tr>\n<tr>\n<td width=\"53\">Tier 2<\/td>\n<td width=\"382\">Covered entity knew or should have known about the violation with reasonable due diligence<\/td>\n<td width=\"69\">$1000<\/td>\n<td width=\"71\">$50,000<\/td>\n<td width=\"75\">$100,000<\/td>\n<\/tr>\n<tr>\n<td width=\"53\">Tier 3<\/td>\n<td width=\"382\">Wilful neglect of HIPAA Rules with violation corrected within 30 days of detection<\/td>\n<td width=\"69\">$10,000<\/td>\n<td width=\"71\">$50,000<\/td>\n<td width=\"75\">$250,000<\/td>\n<\/tr>\n<tr>\n<td width=\"53\">Tier 4<\/td>\n<td width=\"382\">Wilful neglect of HIPAA Rules and no attempt made to correct it within 30 days of detection<\/td>\n<td width=\"69\">$50,000<\/td>\n<td width=\"71\">&nbsp;<\/td>\n<td width=\"75\">$1,500,000<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>There can also be criminal penalties for HIPAA Rules violation that include jail term as specified below.<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"56\"><strong>Tier<\/strong><\/td>\n<td width=\"377\"><strong>Violation Type<\/strong><\/td>\n<td width=\"217\"><strong>Jail Term<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"56\">Tier 1<\/td>\n<td width=\"377\">Reasonable cause or no knowledge of violation<\/td>\n<td width=\"217\">Up to 1 year<\/td>\n<\/tr>\n<tr>\n<td width=\"56\">Tier 2<\/td>\n<td width=\"377\">Obtaining PHI under false pretences<\/td>\n<td width=\"217\">Up to 5 years<\/td>\n<\/tr>\n<tr>\n<td width=\"56\">Tier 3<\/td>\n<td width=\"377\">Obtaining PHI for personal gain or with malicious intent<\/td>\n<td width=\"217\">Up to 10 years<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Common issues leading to non-compliance include:\u00a0<\/strong><\/p>\n<ul>\n<li>Email breaches<\/li>\n<li>Inadequate cybersecurity<\/li>\n<li>Information security risk assessments, and management plans<\/li>\n<li>Business Associate Agreement maintenance, and<\/li>\n<li>Usage of unencrypted electronic mobile devices without password protection.<\/li>\n<\/ul>\n<p><strong>Outsourcing HIPAA compliance:<\/strong><\/p>\n<p>Even large organizations don\u2019t have HIPAA compliance and cybersecurity expertise. Developing internal expertise is difficult, time-consuming, and expensive involving investments of hundreds of thousands of dollars annually. There is also the risk of programs getting neglected due to multiple responsibilities and a lack of domain knowledge.<\/p>\n<p>With a steep rise in instances of a data breach, regulatory requirements, demand for new technology, and customer pressure for data security, many <a href=\"https:\/\/atlanticrcm.com\/outsourcing.php\">healthcare organizations choose to outsource.<\/a><\/p>\n<p>Here are some of the several advantages of\u00a0<strong>Outsourcing HIPAA compliance<\/strong>\u00a0:<\/p>\n<ul>\n<li>Minimizing productivity losses from unexpected downtimes<\/li>\n<li>Cost reduction, zero penalties, and fines.<\/li>\n<li>Staff enablement towards business-critical tasks<\/li>\n<\/ul>\n<p><a href=\"https:\/\/atlanticrcm.com\/outsourcing.php\">Outsourcing HIPAA compliance<\/a> is the best option under current circumstances. With a knowledgeable workforce, required infrastructure and resources, and robust cybersecurity programs they are handling an increasing amount of ePHI. <a href=\"https:\/\/atlanticrcm.com\/\">Atlantic RCM<\/a> is a leader in HIPAA compliance. Working with us, you can expect to gain a competitive advantage, with increased customer satisfaction.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Data breach costs the healthcare industry around $7.13 million every year in the US. Smart technology can reduce breach costs by half, but only 23% of<span class=\"excerpt-hellip\"> [\u2026]<\/span><\/p>\n","protected":false},"author":1,"featured_media":289,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-288","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blogs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Significance of HIPAA Compliance in Medical billing - Atlantic RCM<\/title>\n<meta name=\"description\" content=\"Complying with HIPAA the healthcare industry can reap many benefits. 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