What Is HIPAA Compliance in Medical Billing?

The safety and health of Americans is at the forefront of why HIPAA exists.  Its primary duty is to ensure that patient confidentiality and autonomy are respected, while still allowing medical professionals the room they need to work.

Things can get confusing when HIPAA clashes with how medical professionals have to bill their patients, but they aren’t challenging to understand.  Here’s a look at how to stay HIPAA compliant with medical billing, while ensuring patients will pay what they owe.

Medical Coding and Billing

A large part of HIPAA was reworking the coding and billing systems.  It does this to ensure no fraudulent charges before, during, or after the patient’s visits get added to their account.  The coding that HIPAA sets needs to be followed, with the same procedure receiving the same coding across the entire country.

It doesn’t necessarily change the format of a claim that can be left up to each medical practice to decide: it just makes sure the information is clear and understandable.

HIPAA also manages medical transactions through a format called ASC X120 005010 (usually shortened to HIPAA 5010).  This format covers how the form should get transmitted, instead of how it should get entered.

Every transaction, from what optometry billing services needs- to proctology- each gets its code set number to define it.  They’re similar looking, so it’s essential to keep a close eye on how you format everything.  This system simplifies the codes needed to send things electronically, for the comfort of patients, while also following along with HIPAA guidelines.


One of the most recognizable purposes of HIPAA is to ensure every American has the right to privacy with their medical information.  For billing, this means ensuring that all information, including address, is correct from the start.  Any information, or sending it out incorrectly, can result in a breach of privacy.

The act also controls who can view the files, how you disperse it, and what the paperwork needs to have on it.  Although there are HIPAA-specific forms that any medical firm can use- they can also make their own as long as it follows along with HIPAA guidelines.

It’s crucial, especially with the shorthand tools available to businesses, to follow the guidelines and document everything you need to.  It’s better to have far too much information than not enough in case the documents need to get reviewed.

Because of the sensitivity of these documents, a significant concern is security.


This compliance relies on staff training, and on getting information out to employees quickly.  This system is only as secure as the people who use it.  HIPAA is a continually growing and changing set of rules and guidelines, but they’re always sure to notify all medical facilities when there’s an update.  You can help employees keep up to date, and informed by posting these updates in the offices, emailing them to employees, and discussing them during meetings.  HIPAA is there to protect everyone, not just patients, so keep track of it and make sure you know what to expect.

Steve Max
Steve Maxhttp://www.webzando.com/
A long time digital entrepreneur, Steve has been in digital marketing since 2010 and over the past decade he has built & executed innovative online strategies for leading companies in car insurance, retail shopping, professional sports and the movie & television industry.


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