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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
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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 Institute’s
(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 Association’s Current Procedural Terminology
(CPT-4) and the International Classification of Diseases
(ICD-9) are two of the recognized code sets. Top
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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
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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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