Infusion Compliance Policy for Secure and Accurate Billing
Our Infusion Compliance Policy is designed to ensure that patient information remains confidential, and at the same time, the billing processes are accurate and reliable. We are in line with HIPAA and other industry regulations, and as a result, we are less exposed to compliance risks, we become more transparent, and we deliver to the practice a sense of security. Patient trust and the organization’s integrity are two very important aspects that we keep safe in every single claim at infusion billing services.
Our Commitment to Compliance & Privacy
This Infusion Compliance Policy applies across the full scope of our operations, including:
- All billing, coding, and claims management staff at Infusion Billing Services
- Healthcare providers, infusion therapy clinics, and hospital outpatient departments we serve
- Third-party vendors, clearinghouses, and technology partners who access or process PHI on our behalf
- All forms of communication and data exchange between electronic, paper-based, and verbal involving patient billing and clinical data
Our Infusion Compliance Policy is not limited to a single department. It is a company-wide standard that every team member, at every level, is trained to understand and follow.
Regulatory Framework Behind Our Infusion Compliance Policy
Our Infusion Compliance Policy is built upon strict adherence to the following federal laws, regulatory guidelines, and industry standards:
1. HIPAA - Privacy and Security Rules
The Health Insurance Portability and Accountability Act (HIPAA) is the foundation of our Infusion Compliance Policy as it relates to patient data. We comply fully with the HIPAA Privacy Rule and Security Rule, including safeguarding all forms of Protected Health Information (PHI), enforcing role-based access controls, maintaining data encryption in transit and at rest, executing Business Associate Agreements (BAAs) with all vendors, and conducting annual HIPAA risk assessments.
2. CMS Billing and Coding Guidelines
All Centers for Medicare & Medicaid Services (CMS) infusion therapy billing guidelines are included in our Infusion Compliance Policy. This involves proper use of CPT codes (96360–96413), HCPCS Level II J-codes for drug identification, revenue codes for facility billing and use of modifiers as per CMS guidelines.
3. OIG Compliance Program Guidance
Our Infusion Compliance Policy includes the following seven elements of an effective compliance program as recommended by the Office of Inspector General (OIG). Such as designated Compliance Officer, written policies and procedures, staff education and training, staff communication, internal compliance monitoring and auditing, disciplinary enforcement, and timely response to detected issues.
4. False Claims Act (FCA)
A core principle of our Infusion Compliance Policy is a zero-tolerance approach to false, duplicate, inflated or unsupported claims. All staff are trained on their responsibilities under the False Claims Act and whistleblower protection under the qui tam provisions.
Information We Collect Under This Infusion Compliance Policy
In order to provide accurate and compliant infusion billing, Infusion Billing Services gathers and evokes the following types of information, following our Infusion Compliance Policy:
1. Use of Information:
We use collected PHI and business information only to process insurance claims, manage revenue cycles, verify patient eligibility, communicate with payers, provide analytics to client practices, ensure compliance, and conduct internal audits. We never sell or share information for marketing.
2. Information Sharing:
Information may be shared with insurance payers, clearinghouses, vetted business associates, and client practices as needed for billing and reporting. Disclosure may also occur to meet legal requirements or protect public safety, always in line with HIPAA regulations.
3. Data Security:
We protect information with technical controls, including 256-bit encryption, multi-factor authentication, and secure cloud storage, as well as administrative controls, such as the training of staff, access controls and audits, and physical controls, such as secure facilities and document disposal procedures.
4. Patient Rights
Patients' rights to privacy under HIPAA are represented by their healthcare providers, who can provide access to records, corrections, disclosure accounting, requests to restrict disclosure, requests for confidential communication, and provision of privacy notices. If you have any questions, please contact your healthcare provider provider.
Data Security Standards Under Our Infusion Compliance Policy
Infusion Compliance Policy does not allow for any compromise of data security. All information entrusted to us is secured by a multi-layered, enterprise-grade security system:
Encrypted Data Transmission:
TLS/SSL encryption is used when transmitting or receiving all data concerning PHI to and from Infusion Billing Services. Transmission of sensitive patient data is not sent or received via unsecured channels.
Access Controls and Authentication:
We have implemented a strict role-based access control (RBAC) policy for our staff through our Infusion Compliance Policy, so that they are only able to access data pertinent to their role. All systems used to store or process PHI must have two or more forms of authentication.
Business Associate Agreements (BAAs):
All third party vendors and/or subcontractors accessing our PHI must sign a Business Associate Agreement prior to any transfer of PHI. We have an active BAA Register that is continually updated and reviewed.
Data Minimization:
We adhere to our Infusion Compliance Policy and apply the HIPAA Minimum Necessary Standard when collecting, using and disclosing PHI, which means we only collect, use or disclose the minimum amount of PHI needed to complete our billing and coding obligations.
Data Retention and Secure Disposal:
Billing records are kept for at least seven (7) years for Medicare claims, and for all other payers as per applicable state law. The records are then, upon the expiration of the retention period, destroyed in a way that ensures that PHI is no longer retrievable or readable.
Audit and Quality Assurance Under Our Infusion Compliance Policy
A robust auditing program is central to our Infusion Compliance Policy. We proactively identify and resolve billing errors, documentation gaps, and coding inaccuracies through a multi-tiered audit process.
Pre-Submission Claim Scrubbing:
Before any claim is submitted, it passes through automated and manual scrubbing checks aligned with our Infusion Compliance Policy, verifying: required field completeness, valid and active procedure and diagnosis codes, appropriate diagnosis-to-procedure matching, absence of duplicate claim submissions, and payer-specific billing rule adherence.
Post-Payment Retrospective Audits:
We conduct retrospective compliance audits on a regular basis to identify overpayments, underpayments, or documentation issues with paid claims. ACA's 60-day overpayment rule is followed by any overpays identified, reported and voluntarily returned.
Denial Pattern Analysis:
We have a formal denial management process included in our Infusion Compliance Policy. Denial trends by reason code, by payer and by procedure type are closely monitored to determine if systemic problems exist and to continually improve documentation and coding practices.
Updates to This Infusion Compliance Policy
Our Infusion Compliance Policy is a work in progress. Infusion Billing Services will review and update this policy annually or whenever substantial changes in the regulations, laws or payers take place. The date on the bottom of this page is the most up-to-date version.
Clients and partners are notified of material updates directly. Continued use of Infusion Billing Services following any update constitutes acceptance of the revised Infusion Compliance Policy.
Partner with Us for Compliant Infusion Billing
Make sure that your practice is safe, reliable, and respects the HIPAA regulations. Get in touch with our team to find out how our Infusion Compliance Policy can make your billing more efficient and keep your patient data safe.
Contact Our Infusion Compliance Team
For questions, concerns, or clarifications regarding this Infusion Compliance Policy, please contact our dedicated compliance team:
Infusion Billing Services Compliance and Privacy Office
+1 (281) 817-1727
info@infusionbillingservices.com
30 N Gould St, Ste R, Sheridan, WY 82801
We are committed to earning and maintaining your trust through transparent practices, rigorous standards, and an unwavering dedication to compliant, accurate infusion billing.