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  • HIPAA Model Compliance Plan(ASCA Form)
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    Welcome to healthmedlink.com

  • What is HIPAA?
  • Electronic Data Interchange (EDI) and Code sets
  • Health Care Privacy and Data Security
  • HIPAA and HSS Services/Healthmedlink.com

    What is HIPAA?

    In August 1996, President Clinton signed into law the Health Insurance Portability and Accountability Act (or "HIPAA"). The goals of HIPAA are to protect health insurance coverage for workers and their families when they change or lose their jobs (Portability) and to protect health data integrity, confidentiality, and availability (Accountability). The goals are also to enhance our health care system by making it more efficient, simpler, and less costly. By implementing standard business and system formats we will be able to streamline the processing of health care claims, and reduce the volume of paperwork required in the U.S. health care system. Improved business and system formats will also allow the U.S. health care system to save billions of dollars, and provide better service to providers, insurers, and the public in general.

    HIPAA consists of Titles I-V and places various legal requirements on the health care industry. Title II will have the biggest impact on business partners exchanging electronic transaction data, specifically: Preventing Health Care Fraud and Abuse, Administrative Simplification, and Medical Liability Reform.

    The most important fact that medical practioners should know right now about HIPAA is that full implementation of the regulations affecting us will occur no sooner than October 2002 and April 2003.   Top

    Electronic Data Interchange (EDI) and Code Sets

    The purpose of the Administrative Simplification Section of HIPAA is to encourage the efficient use of electronic data interchange. Since over 400 formats are being utilized today, every payer seems to have different rules and requirements for formatting and transmitting claim data.

    Standardized electronic transaction is the answer to this problem. The final regulation implementing the administrative simplification rules adopts specific standards for eight transactions, including health claims and health care payment and remittance advice. The standards were developed by the American National Standards Instituteís (ANSI) X12N standards. Compliance with theANSI X12N standards will be required by October 2002, and 2003 for small health plans.

    HIPAA also requires Health and Human Services (HSS) to use code sets in connection with the transaction standards. The American Medical Associationís Current Procedural Terminology (CPT-4) and the International Classification of Diseases (ICD-9) are two of the recognized code sets.   Top

    Health Care Privacy and Data Security

    The HIPAA confidentiality and security or "privacy" rules require Covered Entities that engage in HIPAA transactions to protect Individually Identifiable Health Information against disclosure to unauthorized parties. HIPAA also gives patients access to their health records. Covered Entities include physicians, health clearinghouses, and health plans.   Top

    HIPAA and HSS Services

    HSS Services has been closely following HIPAA's rules and regulations. As an experienced health care clearinghouse, we have been using CPT-4 and ICD-9 code sets for data transactions and doing EDI (electronic data interchange) for all of our clients. We are fully ANSI X12N standards compliant (the latest version), which required by HIPAA to be compliance by October 2002. Our senior management is developing written policies and procedures on the following issues: who has access to protected information, how it will be used within the practice and when it may be disclosed. Our privacy officer will ensure that procedures are followed.   Top


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