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HIPAA and medical billing – what’s the connection?

HIPAA and medical billing – what’s the connection?

Medical billing and HIPAA Regulations are primarily familiar to most of us when we visit the doctor or undergo a procedure in the hospital. HIPAA’s main goal is to prevent the misuse of our private health information. This could explain why so many HIPAA-related matters are getting addressed in medical billing and debt collection. When facing medical debt collection, HIPAA can be helpful to us, even if we don’t know it.

How does HIPAA work?

Its full name is the Health Insurance Portability and Accountability Act of 1996, which was signed into law by President Clinton. Its primary goal is to streamline the flow of healthcare information in the United States, although it serves many different purposes. Moreover, it prevents identity theft, fraud, and limitations in healthcare coverage. HIPAA is generally associated with the paperwork you fill out at the doctor’s office in order to limit access to your medical records.

Health Insurance Portability and Accountability Act (HIPAA)

As we’ve stated, HIPAA’s primary role is to protect patient privacy, although it also deals with numerous other issues. 

Under HIPAA, electronic transactions relating to medical billing include:

  • Codes for diagnosing
  • Coding of treatments
  • Codes for transactions
  • Payment formats specific to each company
  • Claim formats in insurance

In spite of all these standards and formats, the goal of all of them is to simplify medical billing and insurance claims by bringing together information across an array of institutions such as:

  • Clinics for health care
  • A hospital
  • Rooms for emergencies
  • Companies that insure

Health Insurance Portability and Accountability Act

Health information privacy is regulated by HIPAA, which has an indirect effect on billing as physicians and their offices must comply with its requirements to safeguard protected health information. As well as ensuring privacy and not using our personal health information improperly, these requirements also define how providers can legally use patients’ health information.

HIPAA regulations should be followed when a medical provider violates them, or if a medical data breach occurs.

 In addition to fines and lawsuits, there are serious consequences. Due to its transfer of sensitive, personally identifiable health and financial information to third parties, HIPAA also impacts medical billing.

Breach of Compliance and Noncompliance

It is certain that the company will likely face fines and other sanctions if it is not compliant with HIPAA regulations. A data breach, on the other hand, is worse than noncompliance. By default, data breaches occur when an unauthorized individual or entity accesses or uses personally identifiable health information. The consequences of data breaches can be very serious. Long and expensive lawsuits result as well as costly forensic investigations, notifications to all affected individuals, and remediation of issues.

Health Insurance Portability and Accountability Act (HIPAA)

A collection agency that deals with medical debt must comply with HIPAA regulations. In order to demonstrate compliance with HIPAA regulations, they must sign a HIPAA Regulations Business Associate Agreement. For collection agencies to collect a debt for medical services, they do not need detailed information about your health and medical history unless those factors pertain directly to the debt.

Whenever they receive protected health information, collection agencies are also responsible for ensuring that the information is kept secure and not accessible to unauthorized persons. 

If a medical debt is turned over to a collection agency, the office or clinic responsible for collecting the debt is responsible for providing the collection agency with as little information as possible.

You may be able to use this as a negotiating point if you believe that the collection agency has too much information about your medical debt. In addition to paying your bill, you can threaten to sue a collection agency for HIPAA violations and force them to delete the bill instead of just marking it paid. If you pay a collection, your credit score will still be affected, but if you delete the bill it won’t.

Dedicated to lowering your Medical Bills

Consumer Medical Bill Solutions specializes in negotiating on your behalf on behalf of billing services and debt collectors to reduce your medical debt to a manageable level. In order for us to begin negotiating for you, you must sign HIPAA paperwork authorizing us to obtain the necessary information. After we have the necessary information, we can usually save you up to 40% on your medical debt. You may not know where to start if you have unmanageable medical bills. Call Consumer Medical Bill Solutions for help!

A medical collection item affects my credit in what ways?

You’re given credit based on a credit bureau’s score and you’re charged interest rate based on that score. As with older scores such as FICO 8, FICO 9 weighs medical collections less heavily than other scoring models such as VantageScore 3.0 and 4.0.

Thus, medical collections might not have such a dramatic effect on your credit score as they once did.

Nevertheless, not every lender is using these updated scoring models. The credit score is just as affected by medical collections as by other types of collections according to previous models, such as FICO 8.

No matter which scoring model you use, unpaid bills can significantly impact your credit score since payment history is the most influential factor.

Because of this, working as soon as possible to resolve medical collections (and other types of collections) is vital. But how?

You can remove medical collections from your credit report by following these steps

You should first check if the reported collection item should even be on your credit report in the first place before you attempt to remove it. A medical collection should not show up on a credit report in the following instances:

  • Over seven years old medical collection items
  • Items less than 180 days old can be collected
  • Payment by insurance (or payment by insurance has been made)
  • If a billing error occurs

Send a letter to the credit bureaus asking them to remove a medical collection item more than seven years old due to its age. 

To find out whether your insurance company paid the bill, you can contact them. Get a letter confirming payment if they have already done so. You should send a copy of the letter to each credit bureau once you receive it. 

Verify that insurance coding is accurate

In case your insurance company still hasn’t paid you, check with them. Identify the reason why it hasn’t been paid. Occasionally, medical bills cannot be paid because of coding errors. The insurance company might pay the doctor’s bill if the code on the bill is changed and resubmitted by the clinic.

Make sure you haven’t made any billing mistakes

You might even not own the bill. Make sure the service was provided. You should ask the hospital or clinic to correct any errors on the bill. Then, contact the credit bureaus and explain what is happening.

Consult the billing department at the hospital/clinic

If your service provider sends you a large bill, you may be able to negotiate. Let them know you’re concerned about excessive charges. Get assistance with payments. You should also inquire about other options for resolving outstanding obligations.

Another option is always available if not.

Your credit report will not include medical bills if you take the following steps

You can avoid medical collections from appearing on your credit report by preventing them from going to collections in the first place. 

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