Medical Billing Services and HIPAA 5010 Compliance

Medical Billing and HIPAA ComplianceThe Health Insurance Portability and Accountability Act (HIPAA) was enacted to ensure that personal information regarding your health is kept private.  This means, if I go to the doctor, the information the doctor uncovers through his investigation can’t be shared with others, allowing me to rest at ease and substantially reducing the likelihood that I avoid the doctor for fear of information about my health status being released.

While HIPAA has been in effect since 1996, changes are continually being made to this law.  The most recent change is the HIPAA 5010, which took effect January 1, 2012.  This modification to the existing legislation dealt specifically with healthcare revenue cycle management.  This 5010 modification specifically stipulated that healthcare professionals must use electronic billing services.

These changes impact everyone from the doctors themselves to the patients who will experience changes in the ways in which they are billed.  Because there can be financial penalties for failure to comply with this legislation, understanding the new requirements is vital for healthcare providers.

This 5010 upgrade was an enhancement upon the 4010 version of this legislation, which also dealt with digital processing of medical billing.  A number of factors lead to this modification.  The major motivating force behind this legislation change was the continued need for high-quality, low-cost healthcare.  This legislation was also implemented to ensure that information could be simultaneously kept private but still relatively easily exchanged between medical offices to ensure that doctors were operating from a place of knowledge.

The hope of champions of this legislation was that streamlining this payment process and using electronic billing and payment methods would also save some cash as processing these payments manually is very labor intensive and, by connection, costly.  Though this transition may be a difficult one, particularly for those who deal directly with healthcare revenue cycle management, once complete the efforts will likely payoff in the form of better, and more affordable, care for patients.


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Photo courtesy of Michal Marcol