HIPAA INFORMATION

What is HIPAA…

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), mandates regulations that govern privacy, security and electronic transactions standards for health care information.

The Department of Health and Human Services (DHHS) has adopted national uniform standards for electronic transmission of certain health information.

They include claim billing and encounter information from providers of health care services to payers of health care, either directly or via intermediary billers and claim clearinghouses.

Who Must Comply…

Those who must comply are referred to as “covered entities”. They come from several major classifications:

Covered Entities:

ü Healthcare provider sole practitioners and physician groups

ü Dentist, Pharmacies, Home Health Agencies, Hospices

ü Health plans

ü Hospitals

ü Clearinghouse,

ü Manufactures of personal devices covered by the FDA and sellers of durable medical supplies

ü Providers who conduct business electronically

What is considered electronic?

ü EDI (837) is a specific Transaction for the healthcare claim, Professional, Institutional & Dental.

ü Internet-web portal or E-mail

ü Direct Data Entry

ü Swipe card Eligibility

What isn’t considered electronic?

ü Paper claims, paper fax

ü Telephone (voice) inquiries

Compliance Dates Re-cap:

10/16/02 Electronic Health Care Transactions and Code Sets Compliance – all covered entities except those who filed extensions and small health plans

04/14/03 Privacy – all covered entities except small health plans

04/16/03 Covered entities must have started software & systems testing

10/16/03 Electronic Health Care Transactions and Code Sets compliance

04/14/04 Privacy – Defines rights of individuals and responsibilities of providers and health plans

07/30/04 Employer Identifier Standard - all covered entities except small health plans.

04/21/05 Security Standard – Defines process and technology standards for electronic protected health information

Does the law require Medicare Claims to be submitted electronically after October 2003?

The exception is that the HHS must grant such a waiver if there is no method available for the submission of claims in electronic form or if the entity submitting the claim is a small provider of services or supplies.

ASCA defines a small (Entity) Provider or supplier as:

1. A provider of services with fewer than 25 full-time equivalent employees.

2. A physician, practitioner, facility or supplier (other than provider of services) with fewer than 10 full-time equivalent employees.

Note: Paper claim forms will not be affected by the HIPAA ruling until October 1, 2006 –May 23, 2007

Privacy Standards

The HIPAA Privacy Standards require physicians to protect the privacy of patients' medical information. Physicians are required to control the ways in which they use and disclose patients' "protected health information." In addition, physicians are required to offer patients certain rights with respect to their information, such as the right to access and copying, the right to request amendments, and the right to request an accounting. Finally, physicians are required to have certain administrative protections in place (such as a Privacy Officer, staff training, and implementation of appropriate Policies and Procedures) to further protect the privacy of patients' information. The compliance date for the Privacy Standards was April 14, 2003.