The new HIPAA requirements are upon us, and there is much confusion regarding its application to ambulance billing. Here are some of the facts:

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. Title II of this act mandates "Administrative Simplification" and requires the Department of Health and Human Services to establish national standards for electronic health care data transmissions and national identifiers for providers, health plans, and employers. In addition, it mandates security and privacy of health data.

The goal of the act is to improve healthcare privacy and encourage standardization and transportability of insurance claims. This is obviously a large undertaking, and as such, the initial focus has been on large healthcare providers and insurance carriers. This has led to some misconceptions regarding electronic filing requirements. Many providers are under the impression that electronic filing will be mandatory regardless of the size of the provider.

While the standardization aspects of the Act will make electronic submissions easier to accomplish, electronic filing is only mandated for large healthcare plans and providers. Providers with less than 25 full time equivalent employees, physicians offices with less than 10 employees, and healthcare plans with less than $5,000,000 in annual revenue, will not be required to file electronically. In addition, providers who are above these requirements will be allowed to apply for a waiver to allow for continued use of paper claims.

If you are a small provider, paper claims may be the most economical and efficient method of submitting insurance claims. In addition, The EMS Accounting System doesn't just print the forms, it allows you to track all your accounts receivable for all patients.

If you are a larger provider, or just wish to file electronically to improve your cash flow, the Electronic Submissions Module will now allow you to submit your claims electronically for a nominal fee per claim.

The EMS Accounting System makes printing and submitting HCFA forms a snap and will improve your acceptance rate by using customized settings for your state's Medicare carrier. In addition, most state's Medicaid claims can also be completed through the EMS Accounting System, as well as virtually all private insurance carriers.

The Centers for Medicare and Medicaid Services is the division of the Department of Health and Human Services that is responsible for implementing HIPAA. Below are some screen-shots from their website at: http://cms.hhs.gov.