September 14, 2022

How has HIPAA changed Claims Processing?

The implementation of HIPAA has affected claims processing in just about every area of healthcare, we’ll discuss how HIPAA compliance has changed claims processing over a period of time.

The traditional method of claims processing is a manual process that can be time-consuming and error-prone. It involves paper forms that need to be completed and submitted to the insurance company. The insurance company will then review the claim and make a decision on whether to approve or deny the claim. If the claim is approved, the insurer will send a check to the policyholder to cover the cost of the damage. Prior to HIPAA, the typical time involved in claims processing was much longer. This was due to the fact that each claim had to be processed manually. This meant that each claim had to be looked at individually, which took a lot of time. Additionally, if there were any errors on the claim, it would have to be sent back and corrected, which would further delay the process. Overall, it could take weeks or even months to process a single claim.

When the Health Insurance Portability and Accountability Act was introduced in 1996, it brought several changes to the way healthcare information was handled. Perhaps most importantly, it established a set of national standards for protecting health information. HIPAA also gave patients new rights concerning their health information, and created enforcement mechanisms to ensure that covered entities (such as hospitals and insurance companies) complied with the law.

HIPAA regulations are in place to properly handle sensitive patient information. The HIPAA requirements ensure that the HIPAA Privacy Rule and the HIPAA Security Rule must be followed to protect protected health information, despite the fact that these criteria are not always simple. To avoid unlawful disclosures, HIPAA regulations standardized safeguards for patient data in addition to privacy standards.


What to Lead to Creating HIPAA?

Health information privacy was lawless before HIPAA was introduced. Medical information was not subject to federal regulations regarding privacy and security. Even though most providers operated pretty well, there was no clear definition of what it meant to protect sensitive information or how it would be governed. Companies used to get detailed updates on their employees' health insurance, but patients couldn't always get their medical information. According to, before the introduction of HIPAA, numerous people had access to a person's health data: doctors, nurses, technicians, clerical workers, and administrative staff, as well as third party personnel in entities involved in healthcare such as health plans, medical supply companies, billing and coding companies, pharmacies, and researchers. To prevent this issue, HIPAA was introduced.

How can Document Automation help Comply with HIPAA?

In recent years, HIPAA has become an important compliance issue for companies that must ensure that their employees’ health information is protected. Document automation can help companies comply with HIPAA by ensuring that sensitive health information is stored securely and is only accessible to authorized personnel. By using document automation, companies can create secure, electronic forms that collect employee health information. This information can then be stored in a secure database that is only accessible to authorized personnel.

Document automation can also help companies keep track of which employees have accessed their health information and when. This data can be used to create reports that show when HIPAA compliance audits have been conducted and what areas need improvement. Document automation can help companies save time and money while ensuring that they are compliant with HIPAA.

HIPAA Requirements for Medical Claims Processing


According to HIPAA, "All healthcare providers, healthcare clearinghouses, and health plans must establish and use standardized formats when transferring electronic data." Medical practices must strengthen their RCM processes in order to lower administrative costs by incorporating HIPAA transactions. The revenue cycle management process (RCM) includes claims administration, payments, and revenue generation, which are the first lines of defense against fraud and abuse in the healthcare system. Here is the procedure for the medical claim processing.


Patient Scheduling: It is the first step in the RCM process. The goal of this step is to collect as much critical patient information as possible. In order to protect patient health information (PHI), medical practitioners must keep it secure and classified appropriately. PHI practices must identify assets and information systems that originate, receive, transmit, or maintain PHI, as mandated by HIPAA regulation. PHI must be recorded in hardware where it is stored or shared.


Data Encryption: Data encryption is another crucial approach for a practice to stay HIPAA compliant during the RCM process. Medical practices should identify these devices and implement hardware and software firewalls as well as update these programs regularly. To ensure HIPAA compliance, the following types of information must be encrypted:


  • Payment information


  • Data from case management


  • Data from laboratories and clinics


  • Transcripts and patient reports


  • Emails exchanged between patients and doctors, as well as between referral doctors


Medical paperwork must be completed as soon as a patient is booked for a session and attends. A practice must keep clean, thorough patient files in order to provide efficient RCM. Services performed to a patient and cash received may be questioned if paperwork is not maintained up to date. To avoid missing information and stay in HIPAA compliance, practices should develop a set of criteria for preserving correct documentation. 


Following that, the standards and procedures should be risk-assessed to verify that they are reasonable and appropriate to provide adequate protection against reasonably anticipated threats or hazards to the confidentiality, integrity, or availability of PHI. If the risk assessment confirms that the standards are acceptable, they should be implemented.


The provider must be reimbursed when the patient's medical data has been recorded and the services have been rendered. However, claims are routinely denied, and expenses are not reimbursed. To prevent this, practices should impose additional revenue-protection requirements.


How does Automating Documentation benefit you?


Over a five-year period, the cost benefits of implementing streamlined workflow processes in healthcare in the United States ranged from $37M to $59M. The main reason for this is an inefficient process.  One of the inefficient processes is manual documentation.  The doctor needs to sign off on every document containing PHI information about the patient.  No one knows how long it will take. It is common for doctors to neglect paperwork in favor of primary activities like healing patients and preserving lives. In addition, doctors must sign documents before they can begin healing a patient.


Automation can help in such a situation. In an automated workflow, a physician, patient, administrator, or other individual can exchange and sign relevant documents in real time, regardless of where they are physically located. Automation bots will alert the appropriate party to sign, examine, or fill out the document. It all depends on the parameters you set.


Why is the New Way Better?

There's no denying that the traditional way of claim processing in the health sector is inefficient. It's time-consuming, paper-based, and prone to errors. Thankfully, there's a new way of doing things that's far superior. It's called automatic claim processing, and it's revolutionizing the healthcare industry.

Here are just a few reasons why the new way is better:

1. It's faster

With traditional claim processing, you have to send in paper claims and wait for them to be processed. Your claims are transmitted electronically and processed much faster with automatic claim processing.

2. It's more accurate :

Automatic claim processing uses computerized systems,  so there are fewer opportunities for errors. This means that you're more likely to get paid correctly and on time.

3. It saves money

Automatic claim processing is more efficient than traditional paper-based claim processing, so it saves money for both healthcare providers and patients. In fact, studies have shown that automatic claim processing can save up to $20 per claim!

4. It's more convenient

With electronic claim processing, you can submit your claims anytime, anywhere - even from your phone! - and get updates.


Why Choose VisionERA for Document Automation?

VisionERA is a proprietary Intelligent Document Processing (IDP) platform for document-heavy businesses. It allows them to process documents 20x faster and their teams to be 3x more productive. VisionERA has a performance guarantee, enabling you to process documents quickly and precisely.

It has an intelligent HI-AI (human intelligence and artificial intelligence) collaboration that allows you to experience the best automation capabilities with minimal human input. You may streamline your document processing activities to help you meet your business objectives more quickly. VisionERA, which is equipped with a continuous learning system, adjusts to better process documents over time.

Here are some of the features that distinguish VisionERA as a truly dependable platform for automating your document scanning process.

Fast Processing of Large Data Sets

VisionERA can assist you in streamlining your business procedures. It enables you to process enormous amounts of data in a seamless and effective manner. There are no errors because the entire procedure is automated. ‍

It can obtain accurate results 

VisionERA is designed to be the best IDP platform on the market. With the algorithm's ability to learn and improve, it can always provide you with the most accurate results. VisionERA streamlines your daily routine and simplifies the process of completing tasks without compromising accuracy. As a proven platform, IDP can assist you in increasing efficiency and reducing costs in a variety of industries and environments.

Real-Life Documents Training

When you use VisionERA, you get a document processing system whose knowledge is based on real-world examples. You must process these documents, and they aren't just a little sample. You can be confident that your documents will be handled correctly when you utilize VisionERA.


The traditional way of claim processing in the health sector is no longer feasible due to the increasing costs and complexity of healthcare.  Using VisionERA IDP for automating the document can speed up the claim processing process and allow you to concentrate on other businesses. 

Contact us today to know more details about VisionERA.

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