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Health care providers are considered "covered entities" under the Health Insurance Portability and Accountability Act (HIPAA) if they submit any of the seven electronic transactions defined under the new electronic data interchange standard. Medicare has mandated that practices of 10 full-time employees or more must submit claims electronically. Other payers are expected to mandate electronic claims submission and may require this of all practices regardless of size. Once a practice begins to submit claims electronically or uses a billing service provider who submits electronically on their behalf, they must comply with the HIPAA privacy rule with respect to protected health information.
What most practitioners don't realize is that compliance is a relatively simple task for the small practice. In fact, it is generally the documentation of formal policies for the privacy protection already provided.
Both practitioners and payers alike can save money with electronic claims submission. For the practitioner, manual preparation of claims is time consuming, error-prone, and takes away from the billable time a practitioner might be able to use to see another patient. In addition, electronic claims submission saves costs for postage, envelopes, forms, and other office supplies. Another significant area of cost reduction will come from being able to check claims status via the Internet versus waiting on hold to talk about five claims at a time.
Our Web site at www.practicesource.net has information about Interactive HIPAA, a compliance tool, and our FAQs lists information about some basic compliance issues, including some free information sites.
Suman Beros
PracticeSource
Hunt Valley, MD
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