The Regulations
Learn More About The Health Insurance Portability And Accountability Act
(HIPAA)
HIPAA is government's largest and most aggressive move in healthcare since the creation of Medicare. It is designed to streamline administrative activities, standardize transactions, and establish privacy and security processes. HIPAA impacts the culture, operations and procedures throughout the healthcare industry.
There are four components to HIPAA: Privacy, Security, Transactions & Code Sets, and National Identifiers.
How HIPAA
Helps
The objectives of HIPAA are to:
• Improve the portability and continuity of employee health insurance
• Guarantee coverage when employees change jobs
• Protect patient's medical and personal information
• Standardize electronic transactions that contain medical data
The Many Spokes Of HIPAA
Privacy:
Ensures the privacy of individually identifiable health information and protected health information
Transactions & Code Sets:
Establishes uniform methods to transmit patient member, administrative, and financial data electronically
Security:
Protects the confidentiality and integrity of electronically transmitted or managed individually identifiable health information
National Identifiers:
Standardizes employers, health plans and providers business identification numbers
Privacy And Security Regulations
Privacy Regulations apply to:
• All member records that contain individually identifiable health information (i.e. name, address, SSN, medical details, etc.)
• All electronic, paper and oral forms of the protected health information are covered
Security Regulations apply to:
• All member records that contain individually identifiable health information
• This Regulation applies to electronically-managed protected health information
Transactions And Code Sets Regulations
T&CS Regulations mandate a uniform standard for transmitting electronic health care data
Transactions modified the processes of:
• Claims
• COB
• Patient and Remittance Advice
• Enrollment/Disenrollment
• Eligibility
• Premium Payments
• Claim Status
• Authorization
National Identifiers Regulations
National Provider Identifier:
• Unique ID number for Providers, used by all health plans
Employer Identifier Number:
• Taxpayer ID number used by the IRS; required for all transactions
National Health Plan Identifier:
• Under development
PHI Defined
Protected Health Information — or PHI — is all the individually identifiable health information and medical information transmitted or maintained!
• How to contact you
• What medications you take
• Where you work
• Where you live
• Your medical history
Simply put…PHI is all the health information on file about you
Who's Impacted By HIPAA?
Organizations Impacted:
• Providers
• Payers
• Clearinghouses
• Billing Agencies
• IS Vendors
• Pharmaceutical Companies
Processes Impacted:
• Enrollment
• Eligibility Verification
• Patient Authorization
• Diagnoses and Procedure Coding
• Claims Processing
• Premium Payments
• Ensuring Security of Medical Records
• Contract Negotiation
• Human Resources and Compliance Processes
• Member/Provider Communications
HIPAA & Service Benefit Plan Members
Member Rights:
• Members may request changes to their information if they disagree with what's on file
• Members may access their medical records
• Members may request a list of who the health plan has disclosed their medical records to
• Members may limit or restrict disclosures
• Members may request confidential communications
• Members may establish a personal representative
• Members may authorize someone to obtain their medical information
HIPAA Compliance Timelines
Privacy:
• Went live April 14, 2003
Transactions and Code Sets:
• Went live October 16, 2003
Security:
• Went live April 21, 2005
National Identifiers:
• Provider Identifiers goes live May 23, 2007.
View The HIPAA Legislation
Should you want
to read the actual HIPAA legislation, you can access it at
http://www.cms.hhs.gov/HIPAAGenInfo/Downloads/HIPAALaw.pdf
