HIPAA eCommerce

HIPAA Insurance and Insurance-Based Medical Billing

Updated  |  5 min read

Any business that collects data covered by the HIPAA Security Rule and HIPAA Privacy Rule is considered a covered entity (CE). This includes hospitals, private practices, medical device suppliers, and pharmacies. All of these CEs work together with insurance companies—also considered a CE—to ensure payment for the patient care they provide.

hipaa insurance

Any healthcare provider will tell you that dealing with insurance is one of their least favorite parts of the job. Patient insurance is always changing, insurance companies need additional information, or an inordinate amount of time is spent collecting insurance information and inputting it into the EMR/EHR.

Every part of healthcare has some aspect of eCommerce, whether it’s collecting payment from the patient directly or engaging with insurance to receive payment. The key to alleviating many problems is letting a patient self-serve as much as possible, whether it’s on a medical app, online portal, or HIPAA complaint website.

The Problems with Taking Insurance

The biggest problem associated with taking insurance is simple: healthcare providers don’t have steps in place to make it easy to input. Though the ability to have patients input their own insurance information is well within the reach of even the smallest PCP, many doctor/patient portals are still behind technologically. The main problems that arise are:

insurance problems
  • Staff Get Stuck with Busywork – There will always be some data entry that staff has to do, but inputting every patient’s insurance information isn’t necessary. Moving insurance information to the patient’s account lets them fill out the information themselves.
  • Patients Can’t Self-Serve – Much like they do with onboarding “paperwork,” patients are becoming accustomed to filling out forms before they get to the doctor’s office. This is even preferable to many patients, as they can take their time filling out forms at home rather than getting to the office and realizing they are missing vital information.
  • Collecting More Than You Need To – The less HIPAA information you transfer, the less worry you have if it is compromised. It’s important to take a thorough look at what you’re collecting and review the need to store it all.

The Benefits of Online Insurance Information

Taking patient insurance information online offers many advantages.

online insurance information
  • Patient Self-Service – Patients can input information at their leisure instead of getting to the office and discovering that they left a vital piece of paperwork at home.
  • Free Up Staff – Staff can verify information instead of inputting it. They can then ask patients about incomplete information when they’re in the office.
  • Insurance Company APIs – APIs allow accelerated decisions from insurance companies about whether they will cover a patient’s bill. A good HIPAA website developer will have access to powerful APIs from most insurance providers.
  • Managing Patient Expectations – It’s important to manage patient expectations by having very specific paths to follow after insurance responses have been requested. Patients need to know that the process isn’t instantaneous, and they also need to be informed about the steps they will have to take—including paying outright—if the insurance company refuses.
What You Can Offer Patients

What You Can Offer Patients

Patients demand much from their healthcare providers. When it comes to their online experience, they typically want two things: Protect their information, and make the experience easy for them.

When you work with the right developer and adhere to HIPAA website compliance, both can be accomplished. Not only can security be improved, but the design tech can give your customers easy methods to enter their insurance information, whether it’s Medicare, Medicaid, private insurance, or something else.

Patient online interaction is usually done by one of three methods:

  • HIPAA Compliant Website – HIPAA websites may collect ePHI when patients are initially contact your healthcare facility via query forms. Even the simplest form needs to be HIPAA compliant.
  • Medical App – Apps are an excellent option for anyone who wants all of their medical information at their fingertips at all times. A HIPAA compliant mobile app can be designed to deliver the same great experience that a website or portal does.
  • Medical Portal – When it comes to filling out long forms—including insurance information—it's likely that most patients will opt to use the medical portal. It must be well-designed so that patients are able to find the information they’re looking for, including the option to pay bills and prompt insurance billing.
patient online interaction

The advantage is that all of these can all work together, with omnichannel capabilities drawing from the same Cloud-based or on-premises servers. Patients can bounce back and forth between all of these options, and the information they provide on one can be accessed from another.

hipaa resources

Enjoy Clarity’s Free Resources

Clarity has been a leader in HIPAA eCommerce for years, and we have dozens of articles on every subject of HIPAA you could imagine. We also offer a complimentary discovery process where we’ll bring business analysts and our tech people together to create a HIPAA plan for your business. You can use this plan to work with us or take it to a different company to work with them.

We like to watch over this space and make sure that everyone is getting the protection they deserve—and must legally provide.

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Stephen Beer is a Content Writer at Clarity Ventures and has written about various tech industries for nearly a decade. He is determined to demystify HIPAA, integration, and eCommerce with easy-to-read, easy-to-understand articles to help businesses make the best decisions.