 The
Health Insurance Portability and Accountability Act (HIPAA)
of 1996 was instituted to provide health insurance portability
for individuals, to protect the privacy and security of patient
health information, and to eradicate fraud and abuse. Also
known as the Kennedy-Kassebaum Act or the Administrative Simplification
Act, HIPAA was enacted on August 21, 1996. The law applies
to all healthcare providers, clearinghouses, and healthcare
plans, any organizations that transmits healthcare information,
and any organization that delivers, bills, or receives money
for healthcare services (and to the vendors or business associates
of these organizations.)
A healthcare provider is defined as
a provider of medical or other health services and those entities
that furnish or bill and are paid for healthcare services as
part of their everyday operations.
The impetus for HIPAA came from
both providers and consumers. Providers wanted standardization
and simplification of healthcare claims. Presently multiple
healthcare claim forms, both paper and electronic, exist. Thus
when transmitting claims data, many times the data must first
be passed through a clearing house which formulates the outgoing
data from the provider to the receiving payer organization,
and vice versa. This "added step" adds both time and cost to
the process. HIPAA standardizes claim submission such that
the sender and the receiver will have the same formage.
Consumers demanded privacy
and security of their patient health information that includes
all oral, paper, and electronic notations. This healthcare
information can be utilized to discriminate in employment settings
and insurance buying. With wide ranging implication, HIPAA
is integral throughout the delivery of quality healthcare.
The Health Insurance Portability
and Accountability Act is comprised of five parts called Titles.
Titles 1 through 5 include Health Insurance Access, Portability,
and Renewal (Title 1), Prevention of Healthcare Fraud and Abuse
(Title 2), Tax Related Provisions (Title 3), Group Health Plan
Requirements (Title 4), and Revenue Offsets, (Title 5). Title
2, Prevention of Healthcare Fraud and Abuse contains Subtitle
F which is Administrative Simplification. Within Subtitle F,
there are six components as follows: Electronic Transaction
Standards, Unique Health Identifiers, Standard Code Sets, Privacy
Legislation, Electronic Signature Standards, and Information
Security.
Further delineation of the six
components results in eleven Rules of the Health Insurance
Portability and Accountability Act.
- Claims Attachment Rule: Will
establish national standards for the format and content of
electronic claims attachment transactions.
- Clinical Data Rules: Will
establish national standards for clinical data. This will include
clinical messaging standards.
- Data Security Rule: Will establish technical and administrative
protocols for the security and integrity of electronic health
data.
- Enforcement Rule: Will establish
rules on how the Government will enforce HIPAA.
- First Report of Injury Rule:
Will establish national standards for the format and content
of electronic first report of injury transactions used in workers'
compensation cases.
- National Employer Identifier
Rule: Will establish the federal tax identification number
as an employer's national identifier.
- National Individual Identifier
Rule: Will establish one patient identifier for all of one's
individual patient health information.
- National Payer Identifier
Rule: Will establish a national identifier for each health
insurer.
- National Provider Identifier
Rule: Will establish a national identifier for each provider
and the mechanisms for disseminating, storing, and updating
the identifier.
- Privacy Rule: Will establish
guidelines for the use and disclosure of patient health information.
- Transactions and Code Sets:
Will establish standard formats and coding of electronic claims
and related transactions.
Instruction Pages:
<<
1
2
3
4
5
>
>>
Back to Top
|
