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Compliance

Your Patient Data, Protected

HIPAA-compliant processes, a signed BAA with every client and secure handling of every claim and record.

HIPAA compliant
BAA with every client
Secure portal
Role-based access

Compliance & Standards

Compliance Built Into Every Claim

Learn about Agile Nexus Solutions compliance standards, HIPAA adherence, and regulatory practices for medical billing and revenue cycle services.

HIPAA Privacy & Security Rules
Business Associate Agreement
Certified coders (AAPC / AHIMA)
Regular coding & billing audits

PHI protectedEncrypted & access-controlled

Rules We Follow

Regulations & Standards Behind Our Work

Every claim we touch is coded, billed and followed up in line with federal rules, payer policies and national coding standards.

HIPAA Privacy Rule

Patient health information (PHI) is used and shared only for treatment, payment and operations, following the minimum-necessary standard.

HIPAA Security Rule

Administrative, physical and technical safeguards protect electronic PHI – access control, audit trails and secure transmission.

HITECH & Breach Notification

Incident response procedures so any suspected breach is investigated and reported to you without unreasonable delay.

Business Associate Agreement

We sign a BAA with every client before we access any patient data, as HIPAA requires for billing companies.

CMS, Medicare & Medicaid Rules

Claims follow CMS billing guidance, NCCI edits, MUEs, local and national coverage determinations (LCD/NCD) and state Medicaid rules.

Coding Standards

ICD-10-CM, CPT®, HCPCS Level II and CDT codes are assigned from documentation by certified coders, following official guidelines.

Fraud & Abuse Laws

Our team is trained on the False Claims Act, Anti-Kickback Statute and Stark Law – no upcoding, unbundling or billing for undocumented services.

No Surprises Act

Support for Good Faith Estimates and patient billing that respects federal surprise-billing protections.

OIG Exclusion Screening

Providers and staff can be checked against the OIG exclusion list (LEIE) and SAM.gov as part of credentialing and enrollment.

Telehealth Billing Rules

Correct place-of-service codes and modifiers (such as 95, GT, FQ) for telehealth visits, following each payer’s current policy.

Payer Contracts & Policies

Timely-filing limits, prior authorizations and payer-specific medical policies are tracked so claims are billed by each contract’s rules.

Fair Patient Collections

Clear, respectful patient statements and follow-up that respect patient rights and applicable collection laws.

Data Security

How We Protect Patient Information

We apply the HIPAA “minimum necessary” standard: our team only accesses the information needed to do the job, on secure systems, and every access can be traced.

Compliance & Regulatory StandardsWe are committed to maintaining the highest standards of compliance across all medical billing and revenue cycle management services.

Unique logins & multi-factor sign-inEvery team member has their own account – no shared passwords – with MFA wherever your systems support it.
Role-based accessStaff only see the practices, patients and functions their job requires; access is removed the same day someone leaves.
Encrypted connectionsData moves only over encrypted connections (HTTPS/TLS, secure VPN or secure file transfer) – never by personal email.
Secure workstationsCompany-managed computers with antivirus, automatic screen lock and no PHI saved on personal devices or USB drives.
Audit trailsActivity in billing systems is logged, so every access and change to patient accounts can be traced.
Trained & vetted staffBackground checks, signed confidentiality agreements and HIPAA training at hiring and every year after.
Secure retention & disposalRecords are kept only as long as needed and returned or securely destroyed when a contract ends.

Our Compliance Program

Built on the OIG’s 7 Elements of an Effective Compliance Program

The HHS Office of Inspector General recommends these elements for third-party billing companies. They guide how we run our billing and coding teams.

1Written policies & procedures
Documented coding, billing, privacy and security policies that every team member follows.
2Compliance oversight
A designated compliance lead is responsible for our program, updates and reporting.
3Training & education
Ongoing HIPAA, coding-update and payer-policy training, including annual CPT/ICD-10 changes.
4Open communication
Staff and clients can raise questions or concerns at any time without fear of retaliation.
5Auditing & monitoring
Regular internal reviews of coded claims, denials and payment posting to catch errors early.
6Consistent enforcement
Clear standards and consequences for anyone who does not follow our policies.
7Prompt corrective action
Problems are fixed quickly – including correcting claims and returning overpayments when required.

Our Compliance Resources

Compliance Documentation & Resources

Access our compliance-related documents and visual resources.

HIPAA Compliance

Fully compliant with Health Insurance Portability and Accountability Act regulations, ensuring patient data protection and privacy through strict access controls, encrypted data transmission and storage, regular security audits, employee training, Business Associate Agreements, and incident response procedures.

CMS Guidelines

Adherence to Centers for Medicare & Medicaid Services billing requirements and guidelines, ensuring accurate claim submission, proper documentation, and compliance with federal healthcare billing standards.

Data Security

End-to-end encryption and industry-leading security measures to protect sensitive healthcare information, including secure cloud infrastructure, multi-factor authentication, and 24/7 monitoring.

Secure Operations Center

Our team works from a secured operations environment with encrypted connections, restricted access, monitored workstations and no local storage of patient data.

Emails and Calls Security Protocols

Encrypted email, verified caller identity and minimum-necessary sharing protect PHI in every conversation with you, patients and payers.

Regulatory Policies & Procedures

Written policies for HIPAA, OIG and CMS rules, reviewed every year and signed by every team member.

Continuous Compliance Monitoring

Regular internal audits of coding, access logs and claim accuracy, with findings fixed and reported to you.

Read our full compliance statement

Compliance & Regulatory Standards

At Agile Nexus Solutions, we are committed to maintaining the highest standards of compliance and regulatory adherence in all aspects of our medical billing and revenue cycle management services. We understand the critical importance of protecting patient information and ensuring that all operations comply with federal and state regulations.

HIPAA Compliance

We are fully compliant with the Health Insurance Portability and Accountability Act (HIPAA) regulations. Our comprehensive HIPAA compliance program includes:

Strict access controls and authentication measures
Encrypted data transmission and storage
Regular security audits and risk assessments
Employee training and certification programs
Business Associate Agreements (BAAs) with all partners
Incident response and breach notification procedures

Regulatory Compliance

Our services adhere to all relevant healthcare regulations including:

CMS Guidelines: Compliance with Centers for Medicare & Medicaid Services billing requirements
State Regulations: Adherence to state-specific healthcare billing regulations
ICD-10 Coding Standards: Accurate and up-to-date medical coding practices
Fraud and Abuse Prevention: Implementation of safeguards against healthcare fraud
Audit Readiness: Maintaining documentation and records for regulatory audits

Data Security

We employ industry-leading security measures to protect sensitive healthcare information:

End-to-end encryption for all data transmissions
Secure cloud infrastructure with regular backups
Multi-factor authentication for system access
Regular security updates and patch management
24/7 monitoring and threat detection

Quality Assurance

Our quality assurance processes ensure accuracy and compliance:

Multi-level review of all claims before submission
Automated validation checks for coding accuracy
Regular compliance training for all staff members
Continuous monitoring and improvement of processes
Documentation of all compliance activities

Our Commitment

Compliance is not just a requirement—it's a core value at Agile Nexus Solutions. We continuously invest in technology, training, and processes to ensure we meet and exceed all regulatory standards. Our clients can trust that their billing operations are in full compliance with all applicable laws and regulations.

Questions

Compliance FAQs

Will you sign a Business Associate Agreement (BAA)?

Yes. We sign a BAA with every client before we access your EHR, practice-management system or any patient information.

How do you access our systems?

Through individual user accounts that you create for our team, with the permissions you choose. You can review or remove access at any time.

How do you keep coding accurate and compliant?

Certified coders code from the provider’s documentation, claims are scrubbed against NCCI edits and payer rules before submission, and we run regular internal coding audits.

What happens if there is a security incident?

We follow a written incident response procedure: contain the issue, investigate, and notify you promptly so HIPAA breach notification duties can be met on time.

Do you help with audits and payer record requests?

Yes. We help gather claims history, remittances and supporting documents for payer audits, record requests and appeals.

What happens to our data if we stop working together?

We return your reports and records and remove our access. Any copies we hold are securely destroyed, as set out in the BAA.

Get in Touch

Contact Us for Compliance Information

Have questions about HIPAA, audits, or compliance documentation? Send us a message and our team will follow up promptly.