HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA)

What is HIPAA?

HIPAA is a law, passed in 1996, which expands your health care coverage if you have lost your job, or if you have changed your job and it protects you and your family in case you have pre-existing medical conditions, and/or problems getting health coverage, and you think it is based on past or present health.

It also Prevents Companies from using your Pre-Existing Medical Conditions to keep you from getting Health Insurance Coverage; Gives you credit for health coverage you have had in the past; May give you special help with group health coverage when you lose coverage or have a new dependent and Generally, guarantees your right to renew your health coverage. HIPAA does not replace the states' roles as primary regulators of insurance.

How will these regulations effect my organization?

These regulations will eventually enable much more efficient and cost effective processing of electronic health information, and simultaneously ensure its increased privacy and security. In practice though, these rules will initially require the re-architecture of the capture, storage, and transmission of electronic health information by all entities that electronically store or disseminate patient health information. These regulations will initially require substantial and time-consuming efforts by healthcare organizations to assess & document compliance.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) promises to revolutionize Health Information Management. Health Plans, Health Care Clearinghouses, and any Health Care Provider who transmits Health Information in electronic form in connection with a standardized transaction should have already begun taking steps to adhere to HIPAA's strict new standards.
Mandated enterprise-wide compliance initiatives will require healthcare entities, over the next two years, to reengineer all processes surrounding the capture, storage and transmission of health information. In spite of the immense scope and initial resource requirements of this initiative, the benefits will be very significant! After these standards have been put in place, a Healthcare Provider will be able to submit data for claims and other standardized transactions using an industry standardized EDI template. All Health Plans are required to accept and process standardized transactions without imposing delays because of format or content. Resulting in:
° Decreased administrative burden - Less time and cost to complete many clinical, billing, and other financial work flow processes.
° More efficient, cost-effective processing
° Standardizes the flow of electronic health information.
° Facilitates improved relationships between healthcare partners.
° Speedier flow of information between entities
° Results in better patient care and decreased reimbursement time.
° Provides a method to conduct streamlined, accurate B2B transaction processing.
° Stricter Security Measures - to protect the physical accessibility of patient health information.
° Greater Privacy protection - to safeguard the disclosure of confidential patient health information.
Standardizing transactions will make electronic data interchange the preferred method of doing business over current paper processing methods.
Ultimately, HIPAA is poised to create a dramatic improvement in the efficiency and effectiveness of the health care system.

Who must comply with the HIPAA codes and transactions?

° Health Plans - individual or group plans that provide or pay the cost of medical care, including Medicare and Medicaid programs
° Health Care Providers - providers who submit electronic transactions for health services must submit the transaction in the standard HIPAA format
° Health Care Clearinghouses - entities that process or facilitate the processing of health information received from vendors or providers
° Vendors - Vendors will need to upgrade information systems to accommodate the new standards for their customers

(Source: www.medicare.gov, http://www2.state.id.us/dhw/hipaa)