Case Study – Billing Software Author

Eagle assisted a medical practice management software vendor with product design, creation of business associate agreements for their customers, revision of their agreement with independent dealers, and client training:

• HIPAA Privacy and Transactions Compliance.  Eagle assisted this vendor with design of new software features to help their clients comply with both HIPAA Privacy and HIPAA transactions.  Transactions compliance included the addition of new data elements to satisfy the situational data requirements of their target customer, design suggestions  for proper accounting with the ANSI 837 COB (electronic secondary transactions), assessment of CMS activities including the their guidance on “contingency plans”, and product functionality to handle the ANSI 270/271 (eligibility) and ANSI 276/277 (claim status inquiry).  For HIPAA Privacy, a number of enhancements were suggested to facilitate the medical practice’s compliance with a number of the HIPAA Privacy provisions.
• Client Training.  A series of client training classes were designed, marketed, and conducted to educate clients on their responsibilities for HIPAA Privacy and HIPAA Transactions compliance.  The training materials a detailed review of policy and procedure requirements for the clients, a guide to the new data elements mandated by the ANSI 837, screen images of the application program highlighting the new data items, and demonstration of new program functionality for eligibility and claim status inquiry.  More than one hundred practices were trained generating revenues of over $35,000.
• Legal and Client Relations.  Eagle recommended that the vendor proactively offer clients a Business Associate Agreement.  Based on the client’s marketing objectives and risk tolerance, a short addition to the client agreement was drafted.  By mailing this to all clients, the vendor was able not only ease the compliance effort for their clients, but also to eliminate the time and effort of reviewing customer-prepared agreements which have proven in many cases to contain onerous and one-sided provisions which go beyond the HIPAA requirements.

As a result of the proactive approach taken by this vendor, appropriate technical, legal, marketing and client service activities were done which provided their clients a smooth transition to compliance with the new HIPAA requirements.  Some of the costs of this major transition were defrayed with client training revenues.