Vikas - I think I am reading the facts correctly this time - billing and collection agencies are not generally "covered entities" under HIPAA. Generally speaking they handle an outsource of patient accounting functions for payors and providers. They are not usually "health care clearinghouses" because they do not typically perform any of the "translations" of either standard data to non-standard - instead they process billing and insurance follow up data for their clients.
If a billing or collection agency is creating or using PHI on behalf of a provider or payor to resolve open patient accounts receivable, it will need to enter into a business associate agreement with each of its "covered entity" clients - i.e., plans it may work with to recover credit balances or to collect unpaid premiums, or providers it may do insurance billing for (usually through a third party clearinghouse) or other collections work. If the billing and collection agency in your example has providers as its client base and is billing, rebilling, doing insurance follow up work, outsourced active A/R management, day 1 self-pay, or straight third party collections, it will need business associate agreements with its covered entity clients the providers. Continuing the thread, when the billing/collection agency interacts with payors, it is doing so as the business associate of the provider, not the payor, and needs no business associate contract with the payors to whom it submits claims. In this fact pattern, the billing/collection agency is not creating or using PHI on behalf of the payors. To switch, many billing and collection agencies work the other side of the equation - studying credit balances on behalf of payors in the patient accounting systems of providers. Under these facts, with payors as clients, billing/collection agencies are creating and using PHI on behalf of the payors and would need BA agreements with their payor clients. Under these facts, no BA agreements with providers would be appropriate because in this situation the billing/collection agency is not really performing a service for the provider -- rather handles an outsourced accounting function (payment under HIPAA) for the payors. As an FYI, the ACA International, non-profit international trade association of credit and collections professionals (www.acainternational.org) has extensive educational materials for billing and collections agencies on implementing and understanding HIPAA. Within that trade association there is a "health services program" with thousands of billing and collection agency members who only handle outsourced payment functions for health care organizations. You may be interested in some of their excellent materials and programs. Is this helpful? Other reactions? I think I have my facts together today. Leslie Leslie Bender, Esq. Leslie C. Bender, P.A. 1922 Greenspring Drive, Suite 7 Timonium, Maryland 21093 Ph: 410-453-4125 Fax: 410-453-4126 www.roiWebEd.com ---------- Original Message ---------------------------------- From: "Vikas Budhiraja" <[EMAIL PROTECTED]> Reply-To: <[EMAIL PROTECTED]> Date: Wed, 4 Sep 2002 16:08:17 -0400 >Thanks for everyone's comments. To clarify the entity in question is a >Billing & Collection Agency. So it has only provider clients. Based on >everyone's input I conclude that this CE would not need any BA agreements >with the payors to whom it submits claims. However, it would need BA >agreements with its providers as the CE is the BA of the provider. Is that >correct? > >Regards, >Vikas > >-----Original Message----- >From: Leslie C. Bender [mailto:[EMAIL PROTECTED]] >Sent: Wednesday, September 04, 2002 12:54 PM >To: [EMAIL PROTECTED]; Jamelle T. Magee >Subject: RE: A Question about Business Associate Agreements > > >Are we all working from the same original facts? I read the original post >to say that one entity, a clearinghouse/billingagency/collection agency, was >in the vortex of a series of transactions and wanted to know if it needed BA >agreements with providers and payors that it found itself in the middle >of -- not that there were 3 separate companies. I apologize if I >misinterpreted the back slashes in the post -- but I didn't see the question >as 3 separate entities asking if each fit the BA definition and how.. > >Clearly a collection agency working for a payer needs no BA agreement with a >provider (that isn't its client) and the converse is true as well. >Similarly a medical billing company working for a provider is its BA -- but >is not a payor's BA because it handles an outsource of the provider's >insurance billing and follow up functions (which equate to "payment" in >HIPAA). > >To me the results change if you have one entity interchangeably being >clearinghouse/billing company/collection agency -- performing multiple tasks >through one corporate entity for the same group of provider and payor >clients (e.g., it isn't a hybrid, doesn't have separate corporate >affiliates...) > >Leslie Bender > > >---------- Original Message ---------------------------------- >From: "Jamelle T. Magee" <[EMAIL PROTECTED]> >Date: Wed, 4 Sep 2002 09:59:30 -0400 > >> >> >> >> >> >> >>WE know that a BA relationship exists b/t provider and clearinghouse and >>no BA relationship exists b/t provider and health plan, per regs. I >>believe that like the provider, no BA relationship would exist b/t the >>clearinghouse and the health plan. However, I have been known to be >>conservative when designating BAs. What's your reasoning Leslie? >> >> >> >> Jamelle >> >>Jamelle T. Magee, JD >> >>Privacy Officer >> >>UNC Chapel Hill Student Health Service >> >>v. 919.843.2584 >> >> >> >> > > > > >________________________________________________________________ >Sent via the WebMail system at mail.theroi.com > > > > > >The WEDI SNIP listserv to which you are subscribed is not moderated. The >discussions on this listserv therefore represent the views of the individual >participants, and do not necessarily represent the views of the WEDI Board >of >Directors nor WEDI SNIP. If you wish to receive an official opinion, post >your question to the WEDI SNIP Issues Database at >http://snip.wedi.org/tracking/. >Posting of advertisements or other commercial use of this listserv is >specifically prohibited. > > >The WEDI SNIP listserv to which you are subscribed is not moderated. The >discussions on this listserv therefore represent the views of the individual >participants, and do not necessarily represent the views of the WEDI Board of >Directors nor WEDI SNIP. If you wish to receive an official opinion, post >your question to the WEDI SNIP Issues Database at >http://snip.wedi.org/tracking/. >Posting of advertisements or other commercial use of this listserv is >specifically prohibited. > > ________________________________________________________________ Sent via the WebMail system at mail.theroi.com The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
