- Electronic Transaction and Code Set Standards Requirements
- Privacy Standards Requirements
- Security Standards Requirements
- National Identifier Requirements
“Protecting your patient's privacy is a part of quality care!”
We understand its clients' concerns about keeping private information private. We have implemented security measures for our site that your medical group or practice and patients are safeguarded.
Professional Billing Service maintains and enforces strict policies regarding access to and use of private information. The company prides itself on its compliance with all applicable laws, including the Health Insurance Portability and Accountability Act (HIPAA).
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is one of the most far-reaching and important pieces of health care legislation ever passed by Congress. It includes many new government mandates aimed at ensuring patient privacy, confidentiality, and security. It also includes national standards for electronic transactions between payers and providers, and requires all providers and payers to comply with these standards.
Professional Billing Service has also taken steps to ensure that our customer service, claim submission, payment posting, claim tracking, and denial processing operations are also compliant with HIPAA Privacy regulations. Similar to what practices will need to do with their own personnel and operations, Professional Billing Service is making sure that our staff and services operate according to policies and procedures consistent with HIPAA and that Professional Billing Service itself has met all HIPAA administrative and procedural requirements.
In addition to regulations concerning patient Privacy and Security, HIPAA also includes rules mandating that all electronic exchanges of health information must be conducted according to specific standards.
Under this requirement, which went into full force on October 16, 2003, all current electronic transaction formats (for claims, eligibility and other important functions) must be replaced by a new, nationally standardized set of transaction formats -- dubbed the "ANSI X12" format set. Not only will this new transaction set require reconfiguration of existing claim formats, but it will also require capture of new data not currently and properly captured in any legacy practice management software. To make things even more complicated, different payors are developing different interpretations on the nature, presentation and use of this data. The bottom line is that a practice that continues to conduct its business as usual after October 16, even if it goes through a clearinghouse that supposedly puts its claims in "standard" HIPAA format, will be non-compliant and will probably experience massive claims failure rates. Software vendors that promise to capture the new data are not themselves submitters of claims and cannot hope to detect and comply with payor-specific interpretations.