Medical practices deal with some of the most sensitive information. Every day, physicians process insurance claims that have in them patient health records, treatment histories, and personal identifiers. With breaches costing healthcare organizations millions and substantially damaging patient trust, securing these claims under HIPAA has gone beyond mere compliance-general protection.

HIPAA's Role in Claims Processing

The Health Insurance Portability and Accountability Act poses stringent conditions on how medical information permeates through the healthcare system. When physicians submit claims to insurance companies, they are transferring protected health information (PHI), and each step has to be handled securely. 

HIPAA is different from records sitting in filing cabinets-it is concerned with any health record that can identify a patient, from diagnostic codes to procedures to how much is billed-a whole gamut. Your claims processing workflow will thus require very robust security measures.

HIPAA Obligations for Physician Practices

Physician practices fall under HIPAA's classification, making them directly responsible for protecting patient information. This responsibility extends beyond your office walls to every partner you work with.

When you submit claims electronically, you're creating a digital trail of patient data. Each transmission point becomes a potential vulnerability. Insurance companies, clearinghouses, and even your own staff represent access points that need protection.

The challenge grows when practices use third-party services. Many physicians rely on physician billing services to handle complex imaging claims. Therefore, physicians should do complete research before choosing the right billing company for their practices.

Why BAAs Are Critical in Claims Security

Any vendor handling patient information must sign a Business Associate Agreement (BAA). This legal document makes them equally responsible for protecting PHI and following HIPAA standards.

Don't assume your billing company or clearinghouse automatically follows HIPAA rules. Even established physician billing services must provide written assurance of their security measures. The BAA should outline exactly how they'll protect data, what happens during a breach, and their protocols for secure transmission.

Technical Safeguards That Actually Work

HIPAA requires specific technical protections for electronic PHI. Start with encryption, every claims file should be encrypted both in storage and during transmission. 

Audit trails will track who accesses what information and when. These trails are important so that suspicious activity can be identified. They are also required to prove compliance in HIPAA audits. In today's systems, practice management systems keep these trails automatically, however, they need to be reviewed regularly.

Administrative Safeguards

Technology alone cannot guarantee the protection of your claims. You also need to establish explicit policies regarding the handling of patient information by your staff at any point in the billing process.

Train your team on HIPAA requirements concerning claims processing. They need to understand what information requires protection, how to identify possible security threats, and what to do when they suspect a breach.

Nominate a HIPAA compliance officer to oversee your claims security. This person should remain abreast of regulatory changes and conduct periodic risk assessments of your billing process.

Protecting Physical Access to Patient Data

Patient information exists in physical form too, printed claims, backup drives, and computer workstations all need protection. Lock filing cabinets containing patient records and restrict access to billing areas.

Facing computer screens away from the public eye is one of the small basic security procedures, while another is to lock workstations automatically after set periods of inactivity. When disposing of equipment, hard drives need to be properly wiped or physically destroyed.

Consider the security of your entire office space. Who has after-hours access? Are patient records visible to cleaning crews or maintenance workers?

Handling Breaches When They Happen

In a breach involving 500 or more individuals, HIPAA confers that the report must be filed within 60 days of the breach. For anything below 500, reporting must be done within 60 days of the discovery of the breach.

Document everything from start to finish. The HHS Department will want a detailed description of what took place, how many patients were affected, what steps you have taken to prevent such occurrences from happening in the future.

Have a response plan entered into before a breach. Know whom to call, information to collect, and how to communicate with the affected patients. The way you respond quickly and openly can make the difference between being an issue that can be controlled and one that feeds on the ability of your practice to continue.

Working with Insurance Companies

As covered entities, insurance companies are responsible for safeguarding the PHI that you send them. However, this does not lessen your responsibility to send the information securely. 

Where possible, use secure portals provided by insurers rather than emailing or faxing. These systems usually provide better encryption and audit trails than conventional ways of communication.

Authenticate the identity of any person who requests patient information, even if it is claimed that he/she represents an insurance company. A lawful insurer does not resort to unsolicited telephone calls or emails for information requests.

The Cost of Non-Compliance

The higher fines are imposed for HIPAA violations, which range from $100 up to $50,000 per violation. To even consider that momentarily, an unlawful disclosure truly jeopardizes a patient's trust and the very name of your practice may also very well be destroyed. 

The Office for Civil Rights pursues complaints and audits for compliance. If a practice fails to prove that it has sufficient security measures, it may be subjected to heavy fines and could be forced to continue on monitoring.

Building a Secure Future

HIPAA compliance is not a one-time achievement; the law mandates continuous adaptation of all security measures. As new technologies come in and threats metamorphosize, your security measures must follow suit. 

Periodic risk-based assessments allow you to pinpoint new vulnerabilities in your claims processing workflow. Keep informed about emerging threats, new security ramifications, and in general security best practices from professional organizations and continuing education.

Physician claims secured under HIPAA standards protect not only your practice but also the patient trust placed in you with the most personal information. In the era of occurring data breaches on a daily basis, this trust is perhaps your most important asset.

The investment in HIPAA compliance yields returns in patient confidence, regulatory peace of mind, and the assurance that every effort has been undertaken to protect the information placed in your care.