Complying with HIPAA’s rules—designed to ensure patients’ personal information stays private—is challenging for any medical practice. It requires a great deal of staff time, and if a practice falls out of compliance, it can be hit with costly penalties. As of 2023, the Office for Civil Rights had imposed over $142,000,000 in penalties across 145 cases. These types of penalties can significantly impact a healthcare organization’s financial health and reputation.
Revenue cycle management (RCM) processes are a great line of defense for hospitals when it comes to ensuring HIPAA compliance.
Where HIPAA Protocols and RCM Intersect
HIPAA and RCM intersect throughout the patient experience, beginning with patient scheduling, medical documentation, claims submission, and continue through account resolution.
It’s essential to recognize that numerous HIPAA rules relate to RCM processes — rules that govern three areas of patient privacy. These areas include the protection of patient health information, the implementation of safeguards to ensure the security of electronically protected health information (ePHI), and the requirement to notify patients in case of a security breach.
- Privacy. Protects individuals’ health information, such as demographic data, that could potentially identify a patient.
- Security. Requires healthcare organizations to implement administrative, technical, and physical safeguards to ensure the confidentiality, integrity, and availability of electronically protected protected health information (ePHI).
- Breach Notification. Medical practices and their associates must notify patients of a security breach in which PHI may have been compromised.
Critical Components of a HIPAA-Compliant Strategy
Administrative and patient care activities—such as scheduling patients, managing medical documents, conducting patient risk assessments, reimbursing providers, and testing the system—must be completed consistently and thoroughly to ensure compliance.
To ensure that those processes are carried out in a way that doesn’t leave the practice vulnerable to compliance failures or data inaccuracies, three RCM best practices must be followed. They include:
Conduct Data Minimization. This principle ensures that controllers and data systems limit the collection of personal information to only what is relevant and necessary and retain data only for as long as needed.
Ensure Data Encryption. These protocols govern the utilization of end-to-end encryption (E2EE), a means of transferring data so that only the sender and intended recipient can view or access it.
Maintain Data Access Control. This rule ensures that healthcare providers allow access to data only by users or software programs granted those privileges.
A HIPAA-compliant strategy should encompass five key activities that relate to running a business and caring for patients:
- Patient Scheduling
- Management of Patient Documents
- Patient Risk Assessment
- Reimbursements to Providers
- System Testing
Key Qualities to Look for in a HIPAA-Compliant Revenue Cycle Provider
When selecting a partner for outsourced revenue cycle there are several factors to consider to ensure HIPAA privacy and compliance:
- A strong track record of adhering to HIPAA standards
- Regular training programs for staff, emphasizing HIPAA, privacy, and data security protocols
- Encryption technologies and secure data transmission methods, including HIPAA-compliant software and systems for managing sensitive patient information
- Regular audits and vulnerability assessments to identify and address potential weaknesses.
- Transparent policies for data access, sharing, and storage
- Documentation on how patient information is protected at every stage of the revenue cycle
- Well-documented, swift incident response plan for addressing data breaches or compliance failures.
- Third-Party Audits and Certifications, such as HITRUST, which further demonstrate their commitment to data security and compliance
These elements will help safeguard patient information and ensure compliance with HIPAA regulations in the revenue cycle.
Summary
Developing an effective and sustainable HIPAA compliance strategy can be daunting, but choosing the right RCM partner greatly increases a practice’s chance of remaining compliant over the long term, avoiding harsh penalties, and protecting patient privacy while saving valuable time and cost.