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HIPAA & Medical Billing Software

Common Questions regarding HIPAA and Medical Billing Software

We've heard some alarmingly incorrect information about how HIPAA really affects an office. Many people mistakenly believe that as long as their medical billing software is HIPAA compliant (or their electronic claims clearinghouse), then they are in compliance. This is WRONG!

If you send a claim electronically, you automatically become a "HIPAA Covered Entity" which means you are legally required to be FULLY HIPAA compliant.

This cannot be emphasized enough, even if you are using InstaClaim (which is HIPAA compliant) and/or clearinghouses that are HIPAA compliant, you are NOT HIPAA compliant unless you complete all the required forms AND have your patients sign all the proper paperwork AND complete the proper training. You must be HIPAA compliant in ALL of the following four categories:

Electronic transactions,
Privacy,
Security, and
National identifiers (this includes the NPI - which you should already have by now).

If you paid someone to do the research and try to find all the forms you need, you would pay MUCH more than the cost of the HIPAA Complete book and CD. We have reviewed many seminars and other HIPAA compliance products and this is by far the simplest and easiest that we have found. Not to mention that the price is extremely reasonable. HIPAA Complete is really the least stressful way to HIPAA compliance that we have found!

HIPAA FAQs

Q: If I fax a claim to an insurance company, is that a HIPAA transaction?

A: If you fax from your computer, then it becomes a HIPAA transaction and you become a HIPAA covered entity. If you use a separate fax machine, it does NOT automatically make you a HIPAA covered entity.

Q: Why should I worry about being HIPAA compliant? Who's really going to know anyway?

A: You should care because each violation has a $100 civil penalty and up to a $250,000 criminal penalty and/or up to 10 years in jail. It is NOT worth taking a chance.

Q: How can I find out if I (or a business I work with) is a HIPAA covered entity?

A: CMS has created a nice little document to help you figure it out. You can read and/or download their "Covered Entity Charts" by clicking here.