In this digitally smart world, every sector is moving at a fast pace and the healthcare sector is no exception. Healthcare Practices possess sensitive information about their patients in different medical billing software. That is the reason why cyber-attacks frequently target the healthcare sector. The intention is to steal a patient’s sensitive data and exploit the information. The shocking part is that data breaches in healthcare actually cost US businesses more than $6 billion every year. To protect healthcare from the constant assault of threats, it is important for them to comply with HIPAA compliance rules.

Let’s Understand HIPAA

HIPAA, which is also abbreviated as Health Insurance Portability and Accountability Act, is an essential piece of legislation enacted in the United States in 1996. The aim was to safeguard sensitive patient health information and establish specific rights related to healthcare privacy. When we talk about medical billing software, HIPAA means that all parties involved in the process, including healthcare providers, billing companies, and insurance entities, must adhere to the strict guidelines set forth by the act.

Although many healthcare-related concerns are covered under HIPAA, it specifically addresses privacy and security concerns that are associated with protected health information (PHI). There might be serious consequences from unauthorized access, data breaches, and mishandling of PHI. This ranges from compromising patient privacy to financial loss which results in reputational damage for various healthcare organizations.

To protect patient’s privacy and to ensure compliance, it is important to understand and implement HIPAA's provisions and best practices while choosing a medical billing software.

In this blog, let’s understand the role of HIPAA in medical coding & billing and finally explore the best ways to achieve and maintain HIPAA compliance in the healthcare organization.

The important part to consider is that the third-party vendors, like medical billing software who are providing services to its entities, must also be HIPAA-compliant. If your healthcare fails to do so, it may lead to serious consequences, which includes heavy fines and action against your license.

Role of HIPAA in Medical Billing Software

Privacy of Patients

HIPAA establishes strict guidelines to protect the privacy and confidentiality of patients. It demands all the healthcare providers, and those who are involved in medical billing, to implement measures to safeguard the information of the patients. It includes maintaining any personally identifiable information including the privacy of patient's medical records and billing information.

Therefore, the medical billing software you choose must be HIPAA compliant in order to ensure the privacy of the patients.

Electronic Transactions and Code Sets

When your software is HIPAA compliant, it mandates standardized electronic transactions and code sets in medical billing. This standardization will make sure that consistent formats and codes are used by healthcare providers while submitting and processing claims electronically. Standardization ensures a simplified billing process, enhances efficiency, and reduces errors in the long run.

Set Security Standards

When you have HIPAA-compliant medical billing software, it sets specific standards to protect electronic PHI (ePHI) and data from unauthorized access, use, or disclosure. It is a necessity for healthcare organizations to implement administrative, physical, and technical protection to maintain the integrity and security of patient information. It also includes access controls, encryption, staff training, and audits. Getting medical billing software that is HIPAA Compliant, like Unify Medicraft is a step in the right direction.

Privacy Notices and Consent

HIPAA compliant medical billing software requires healthcare providers to notify patients about their privacy practices. This is a document which explains how the provider uses and protects its PHI and the patient's rights regarding their information. Patients must provide written consent for releasing their PHI. The exceptions are the cases where the information is required for treatment, payment, or healthcare operations.

Risk Assessments and Audits

Vulnerabilities and risks to patient information are identified by conducting regular risk assessments. It is important for the providers to comprehensively analyze their systems, processes, and physical infrastructure. This helps in identifying security gaps and taking appropriate measures to overcome them. Additionally, conducting audits periodically ensures ongoing compliance and identifies areas that require improvements.

Provide Technical Safeguards

It is important to implement robust technical safeguards, for protecting ePHI. When you have HIPAA-compliant medical billing software, you will be able to employ strong access controls. These controls include unique user IDs and passwords, encryption of sensitive data, implementing firewalls and intrusion detection systems, and regularly updating and patching software systems. This helps to address vulnerabilities.

Physical Safeguards

Apart from getting HIPAA-compliant medical billing software, physical security measures should be in place to protect physical access to areas where PHI is stored. This can be done by restricting access to data centers, secure storage of paper records, and proper disposal of physical media.

Let’s Discuss the Security Features of HIPAA Compliant Medical Billing Software

HIPAA demands the confidentiality, integrity, and availability of protected health information (PHI). Because of which it becomes a necessity that there are security measures in place to safeguard it.

When organizations are looking for a HIPAA compliant medical billing software, they should look for the following features:


Encryption is the best way to secure data. It is a perfect way to mask your sensitive data by turning it into a format that can only be read by authorized individuals possessing a decryption key.

Data Backup

In case there is any event of a breach or a natural disaster, there is a need to protect data. Therefore, it is necessary that medical billing software implements offsite data backup. Data backup facilitates data to be restored quickly when the original copies are damaged or stolen in any case.

Access Controls

Organizations should only grant access to the components of the medical billing software that employees require to complete their job functions. This should be done with the use of unique login credentials. This HIPAA requirement is termed as the minimum necessary standard.

Audit Controls

To ensure adherence to the minimum necessary standard and facilitate the quick detection of breaches, HIPAA requires PHI access to be regularly tracked. When you keep an audit log, it allows healthcare organizations to establish regular access patterns to PHI. This makes it easier for the administrators to detect the cases when PHI is being accessed outside the norm. HIPAA-compliant medical billing software enables organizations to track data that is being accessed through the platform.

User Authentication

It is an important part as it ensures that users are who they appear to be while using the unique login credentials. HIPAA compliant medical billing software must have a means to provide unique login credentials for each user within the organization. Multi factor authentication (MFA) is a form of user authentication which offers increased security. MFA requires users to input multiple login credentials to access data such as a username and password.

Transmission Security

Adding transmission security provides an additional layer of security with its end-to-end encryption (E2EE). E2EE secures both data stored in the medical billing software and data being sent through your medical billing software.

Driven by the impact of the constantly evolving environment in the healthcare industry, digital healthcare transformation has become a new norm. Therefore, it is obvious to see a sharp shift towards a focus on healthcare compliance adherence.

If you are also planning to build HIPAA-compliant software, the experts of Unify Medicraft are here to assist you. We implement strategies in place to carefully meet HIPAA requirements and make your revenue cycle management easier than before.