Why Protecting PHI in Revenue Cycle Management Is Critical?

Hospital billing systems deal with tons of personal data of patients in a single day. This data consists of name, address, social security number, and medical records. It is not only important to keep this data safe, but the law also demands it. Hospitals that do not do anything to protect the information of patients are subjected to massive fines and loss of trust by the patients.

The revenue cycle management entails numerous processes between the time a patient comes in to the time a patient pays the final bill. Every level offers an opportunity to steal information by hackers.

Understanding PHI Vulnerabilities in RCM Workflows

Common Security Risks in Revenue Cycle Management

The majority of individuals are unaware that the extent of the patient information is passed between when the bills are being calculated. Your data is sent to insurance agencies, billing offices, and payment gateways when you go to see a physician. Every destination on the route poses an additional threat to your confidential information.

More than you would expect, workers do make mistakes. At times, they even transmit patient files to the incorrect email address. In some other cases, they walk away, leaving open computer screens with confidential data within the view of others. They can also fail to lock up filing cabinets and discard papers without shredding them.

The other problem is the establishment of outside companies that assist with billing. These enterprises require patient information to perform their duties. However, not every one of them provides decent security practices. There are others who operate through old computer systems, which can easily be hacked. Others fail to train their employees on how to handle information privately.

Data Breach Consequences and Financial Impact

When the patient data is stolen, hospitals are in big trouble, which is far more than a simple fine. The government initiates investigations that may run for years. Attorneys bring civil lawsuits, which take millions of dollars in defense costs. The hospital’s image is tarnished, and it will take a long period of time before trust is restored.

It is easy to accumulate money issues when data is breached. Hospitals are forced to pay computer specialists to determine what went wrong. They engage the services of court litigators. They are also obliged to cover credit monitoring services for patients whose data was hacked. All these expenses may amount to millions of dollars.

The patients will lose their trust in hospitals once their confidential data is stolen. They fear visiting doctors who are not able to keep their secrets safe. Certain patients deny the truth in their medical history as they are afraid that their data will be stolen again. This increases the difficulty in providing good care by the doctors. Hospitals have to select an individual who will be in charge of adhering to HIPAA regulations.

Best Practices for Secure RCM Workflows

Establishing Robust Access Controls

The golden rule of patient data security is simple: people should only see what they need to do their job. A person who schedules appointments doesn’t need to see billing information. Someone who processes payments doesn’t need to see medical test results. This approach limits damage if someone’s account gets hacked.

Computer systems should automatically give people the right access based on their job title. When someone gets promoted or changes departments, their access should change too. Hospitals should review who has access to what information at least once a year. Old accounts from people who quit should be deleted immediately.

Vendor Management and Third-Party Security

Hospitals collaborate with numerous external firms that have a certain need to access patient data. These may be billing agencies, collection companies, or technology vendors. All these relationships cause a possible security threat that should be handled by the hospitals.

Business Associate Agreements are legal documents that provide details on how external companies should handle the information of the patient. Such agreements should involve some security requirements and the implications of violating the rules. Hospitals are supposed to check these contracts regularly and revise them as the rules change.

Evolving Cybersecurity Landscape

Hospitals are experiencing dynamic threats all the time. The ransomware attacks have been particularly prevalent in recent years. Such attacks lock the files of hospitals and require money to make them accessible. Hospitals are specifically targeted by criminals since they are aware that patient care requires access to medical records.

The new opportunities and the new threats are being introduced by artificial intelligence. Although the hospitals can use the AI to identify any abnormal behavior of their network, the criminals are also embracing the technology to produce more advanced attacks. The hospitals must be aware of such developments and change their security strategies accordingly.

Regulations imposed by the government keep advancing with the advancement of technology. New laws may introduce more security measures or alter reporting requirements. Hospitals have to keep up with all these changes and make their policy accordingly. An active approach to compliance prevents penalties.

Strategic Planning for Long-Term Security

The hospitals are required to consider security as an investment rather than a one-time cost. They will also need altered security as they expand and introduce new offerings. Advance planning is the key to making sure that security does not appear as one of the obstacles.

Investment in security is worth it. Good security systems and trained personnel come at a fraction of the cost of addressing the breach of data breach. Most hospitals that skimp on security usually pay a lot in the future when it all goes wrong.

Security does not just happen; once you have set it up, and forget it. Threats evolve, technology evolves, and rules are updated. The fact that the hospital is constantly trying to improve the way it protects the data demonstrates to the patients and other regulators that the hospital is serious about protecting the data.

Conclusion: Security is Important

Securing patient information in the hospital billing systems takes careful planning and continual efforts. Hospitals should consider security in each stage of the billing procedure. Starting with the arrival of the patients to the time they finish paying their bills. The connected nature of modern billing systems creates many opportunities for criminals to steal information.