Health Information Compliance Alert

Published on Sun Jan 15, 2006 PDF

Question: We are moving to electronic billing but currently submit paper claims. Do we need to establish a business associate agreement with our billing service? Does it matter if our billing service converts those paper claims to electronic ones?

New Mexico Subscriber

Answer: "If they use an entirely paper process, then they do not need a business associate agreement as of today," says Gwen Hughes, Director of e-HIM Consulting Services at Chicago's Care Communications.

However, "once you put your toe in the electronic stream, HIPAA applies," asserts Clark Stanton, an attorney in the San Francisco office of Davis Wright Tremaine. Remember: This conversion doesn't have to take place in your office.

In the Centers for Medicare & Medicaid Services FAQs, CMS states that a billing service that converts paper claims into electronic claims is, in fact, a clearinghouse. Because the billing service is "acting on behalf of a covered entity," it is a business associate, says CMS.

The Bottom Line: You need a business associate agreement with a billing service if you are submitting any electronic claims, experts agree. However, you also need it if your billing service is doing the electronic work for you.
 
Tip: "If all you're doing is paper" at all levels, then you aren't a covered entity, explains Jason Levine, a consultant with Murer Consultants in Joliet, IL. However, "if you're doing any electronic claims, then you absolutely need a business associate agreement," he clarifies.