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Compliance


The Health Insurance Portability and Accountability Act of 1996 (HIPAA) outlined changes in the provision of healthcare and the management of paper and electronic records. Such changes focused primarily on defining standards in

  • Medical information transport,
  • Medical transaction set formats for transmitting or handling electronic claims, remittance, and eligibility information, and
  • Overall protection and confidentiality of patient-identifiable information.

e4e healthcare services is fully compliant with each of HIPAA's requirements.

HIPAA-Compliance

e4e recognizes the importance of protecting the privacy and integrity of every patient’s health information. Following are the initiative taken company wide to protect PHI.

Privacy

We recognize the importance of the Privacy and Security requirements under HIPAA. Therefore, we have taken several steps to ensure that PHI entrusted to us in the course of billing and related activities are fully protected in conformance with the letter and spirit of the regulations.

Every employee signs a confidentiality agreement with severe penalties for HIPAA violations

Access to applications/databases defined on ‘need-to-know’ and ‘minimum- necessary’ basis

HIPAA compliant procedures defined in risk areas like:
  • Fax and email communication to external agencies
  • Information disclosure to payers, patients, family members and others
  • Storage, retrieval and/or disposal of reports and physical records
  • Common resources such as scanners and copier machines

Back-to-back chain-of-trust agreements with our vendors such as security staff and housekeeping staff

Security

  • Physical and electronic access restrictions to work area and network
  • Firewall protection for internal network from the world wide web
  • Enterprise-wide multiple virus protection systems
  • 128-bit SSL and data encryption on all web based applications
  • Each user has unique login, power-on and screensaver passwords
  • Controlled media usage/movement through inventory logs and physical checks
  • User accounts to access shared resources like fax machines and photocopiers
  • Random screening of emails for attachments with PHI
  • All documentation is kept on our proprietary electronic Document Management System, which is protected by stringent rules of user access, logins and passwords

Transaction standards

Our systems and processes completely support the usage of the new transaction and code sets under the HIPAA standards provided your third-party or proprietary software supports the same. If you are utilizing the services of a clearinghouse in transmitting claims, we can continue, without altering the arrangement. We currently work with several clearinghouses across the USA, for the transmission of claims and patient bills.

Our proprietary practice management software Velocity, is completely HIPAA compliant. The following transaction sets, are available as part of the standard application:

  • Claim Transmission- ANSI X12N 837 4010A1
  • Payment and EOB - ANSI X12N 835 4010A1
  • Claim Status check and update - ANSI X12N 276/ 277
  • Eligibility checks - ANSI X12N 270/ 271

While the various players continue to move towards full compliance with the new HIPAA standards, we also support various other transmission formats such as the NSF and the print image of the CMS-1500.

Our proprietary practice management software Velocity, has several such built-in safeguards:

  • Audit trails and modification logs to ensure the traceability of changes made to PHI
  • Non-TPO PHI disclosures are logged into the software system. Information on disclosures can be retrieved at any time
  • All access to the software is based on logins and passwords, linked to a system of user-groups and rights, ensuring conformance to our ‘minimum-necessary’ policy
  • Data is backed up daily and an offsite backup maintained as part of our Disaster Recovery Policy
  • Additionally, wherever feasible, we have a database replication setup to the client's server
  • The software works in conjunction with our proprietary electronic Document Management System. This ensures very limited printing and electronically protected, yet easy, retrieval of billing records
  • Eligibility checks - ANSI X12N 270/ 271

Staff Education / Training

  • Frequent awareness programs cover all employees, old and new, periodically
  • Ongoing, online tests measure awareness and link HIPAA conformance to staff rewards
  • HIPAA resource directory is available on the Intranet to update employees on regulations, news and events
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  • Comprehensive Policies for all Relevant Laws
  • Company Wide Training
  • Continuous and Independent Audits
  • Process Oriented Implementation
  • Streamlined Incident Handling Process
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