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Electronic Billing Requirements

When it comes to maintaining records, many health care providers have converted their paper records to electronic records. With the conversion to digital record keeping, offices are also able to bill their customers and clients electronically. Any time private health information is sent electronically over the Internet, it is important for service providers to adhere to electronic billing requirements, which may vary by the type of professional service and state.

  1. Nationalized billing standards and HIPPA compliance requirements

    • National standards help to direct the way health care bills are maintained and disseminated. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects patient privacy and creates uniformity between the approximately 400 health care claim formats in use today. To conform to HIPAA standards, health care groups such as the American Dental Association (ADA), National Uniform Billing Committee (NUBC), National Uniform Claim Committee (NUCC), and Workgroup for Electronic Data Interchange (WEDI) must work together to create systems that meet privacy and uniformity electronic billing requirements. If a health care provider or entity does not conform to the electronic billing HIPAA requirements for his or her state or industry, the provider or entity may be fined up to $100 per penalty, up to a $25,000 cap.

    Minnesota Department of Health mandatory electronic bill requirements

    • States can have their own requirements when it comes to how electronic bills are sent and regulated. In the state of Minnesota, health care providers must use the e-billing system. Minnesota is the first state in the nation to enact the mandatory e-billing law, which took effect on July 15, 2009 and impacts the 60,000 health care professionals, including hospitals and private practice providers who collectively process more than 55 medical bills. With the mandatory electronic billing requirement for the state, the state's health care system saves approximately $60 million per year.

    Medicare and Medicaid electronic billing requirements

    • There are electronic billing requirements specific to the Medicare and Medicaid program for providers wishing to use the Electronic Data interchange (EDI) interface. According to the U. S. Department of Health & Human Services, electronic health care claims---or bills---must be sent from a health care provider's office through an approved computer that has software that meets HIPAA claim standards. Health care providers can obtain the approved electronic submission software they need to meet electronic billing regulations from approved vendors, or they can obtain the software for free through some Medicare suppliers.

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