HIPAA Compliance

The Importance of HIPAA Compliance by PreMD Medical Billing Services

Currently, the healthcare system is going through a serious phase that involves shifting models, from the volume-based model to the value-based reimbursement system. All of this is intended to minimize healthcare costs.

PreMD is a HIPAA medical billing company and as a business associate, it conducts the Risk Assessment within the organizations and pays ultimate regard to the PHI and ePHI. We are in touch with the electronic versions on a daily basis, and, therefore, place all the particular safeguards for security.

By performing a Risk Assessment, we exhibit HIPAA compliance and ensure an administrative, physical and technical safe sector to receive, store and transmit patient and provider health information.

Quality Payment Program (QPP) came to life under MACRA splitting out into MIPS and APMs. Ultimately, better patient-reported outcomes (PROs) will choose the fortune of those physicians participating in both these programs. MIPS can be the silver lining that may change the entire face of US health care industry. In addition, participating in MIPS individually or in the form of groups entirely depends upon you.

HIPAA Requirements for Electronic Claims
PreMD medical codes follow certain standards. These codes, as we know, form the basis of electronic claims. The medical billers and coders are bound by law to create & submit claims using an accepted format. We know this format as ASC X12 005010 or HIPAA 5010.

When does HIPAA Compliance Come in?
If you are a multiple services provider offering Medical Billing Services along with MIPS consultancy, you must exhibit HIPAA compliance while handling PHI and the patient records. EHRs contain sensitive data that needs protection, hence, a secure network.

It is a compulsory and an obvious part of professional care delivery. If you, as a physician, are not following proper guidelines set forth by governing bodies, to preserve and protect PHI, you are exposing yourself to several problems. If that information gets out, it can easily be used to financially and expressively harm the people related  to it.

HIPAA Compliance (An Essential Part of the Electronic Medical Billing Services)

Why do we need to secure information provided in hospitals or private practices?
1. Keeping in view the financial aspect, your social security number is very much part of the PHI. If there is a breach, the consequences can be unimaginable.

2. Protected Health Information (PHI)

3. PHI is anything from a patient’s name, address, phone number to the social security number and account number. It is basically everything.

Severe Penalties for the Guilty
Guidelines released by the mutual understanding of HIPAA OIG and the Healthcare Reform Act of 2010 are the standards for in-house and outsourced medical billing services. Following them will enforce safety measures around ePHI’s exchange and storage. With this in mind, scrutiny can also come into effect if PHI is mistakenly lost or stolen outside the assigned address. Hence, only by strict adherence and disciplined approach, you can keep away from fines and reputational losses.

✓ HIPAA Violation Minimum Punishment Maximum Punishment
✓ Unintentionally $100 per violation; $50,000 per violation; Maximum $1.5 million in a year
✓ Maximum $25,000 for repeated violations in a year
✓ Reasonable Cause $1,000 per violation; $50,000 per violation;
✓ Maximum $100,000 for repeated violations in a year Maximum $1.5 million in a year
✓ Willful neglect but a violation is dealt with during the required time period $10,000 & $50,000 per violation;
✓ Maximum $250,000 for repeated violations in a year Maximum $1.5 million in a year
✓ Willful neglect but a violation is NOT dealt with during the required time period $50,000 per violation with a maximum penalty of $1.5 million in a year $50,000 per violation with a maximum penalty of $1.5 million in a year

Prepare Yourself for an Extra-Load of Claims
Medicare enrollees, under the Healthcare Reform Act, are entitled to free screenings for cancer, diabetes, and HIV. This means more claims will be filed with MACs or Medicare administrative contractors. Medical billing services need to be ready for the additional workload so that their performance stays intact.

PreMD Security
All covered entities and business associates must have a constricted security plan. The HIPAA Security Rule has three basic components.

1. Administrative Safeguards
By designating a security officer, executing a plan to prevent unauthorized access, training the hospital staff and supervising them, analyzing the security rules and regulations from time to time, we are well-set on a HIPAA acceptable journey.

2. Technical Safeguards
These security guidelines mean confining access to offices, workstations, work areas, tablets and other cell phones which contain ePHI. Going the data through encryption mechanisms is the correct method to deal with important data.

3. Physical Safeguards
These measures identify the rules and regulations that must be in place to ensure data security. The electronic information, buildings, and the equipment need protection from natural and environmental disasters, unauthorized access and any other harmful events that may expose the patient health information



For more than 25 years, we’ve been helping physicians, clinics, group practices, and hospital-owned physician groups with their medical billing. Our medical billing and practice management consulting services can be used for all types of medical practices and medical specialties including:

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