The following questions cover general, privacy, and transactions and code sets. They will give you an overview of HIPAA.
Who Must Comply With The HIPAA Administrative Simplification Regulations?
The entire health care industry and those organizations that contract and do business with:
- Health Plans such as Blue Cross and Blue Shield
- Federal programs such as the Service Benefit Plan and Medicare
- Health care clearinghouses, such as WebMD and ProxyMed, who receive and transmit electronic claims information for providers in the Blue Cross and Blue Shield Plan network
- Providers - physicians, hospitals, pharmacies, and any provider who bills electronically and is defined by Medicare as a provider.
Why Is HIPAA Needed?
Health care providers have a strong tradition of safeguarding private health information. But in today's world, the old system of paper records in locked filing cabinets is not enough. With information broadly held and transmitted electronically, the HIPAA administrative simplification provisions provide clear standards for all parties regarding protection of personal health information.
What Kind Of Member Rights Does HIPAA Give You And Your Families?
For health plan members and for you and your family as health care consumers, HIPAA means being able to make informed choices when seeking care and getting reimbursement for care based on how personal health information may be used. For example:
- It enables members to find out how their information may be used and with whom the information has been shared.
- It generally limits the release of information to only what is reasonably needed for the purpose of the request.
- It gives members the right to examine and obtain a copy of their own health records and request corrections.
Can A Member Request That A Particular Person Or Plan Employee Not Have Access To Their Personal Health Information Because They Are Related To Or Know The Member?
Yes, they can. This is essentially the framework of HIPAA's privacy regulation. The individual could limit his or her consent by specifying individuals who may not access the individual's PHI.
Will The Privacy Regulations Jeopardize The Quality And Timeliness Of Patient Care And Drive A Wedge Between Members And Their Providers?
The regulation will improve the quality of care and the patient/professional relationship. Concerns about lack of privacy now drive a wedge between patients and their providers and impede the provision of quality care because patients withhold information, avoid asking certain questions, or fail to seek care altogether. Among other benefits, the regulation creates the opportunity for patients and their health care providers to engage in a dialogue about how their information will be used and gives patients more control over uses and disclosures. This regulation will go a long way toward promoting confidence in the privacy of medical information and in the health care system.
What Is The Purpose Of The HIPAA Transactions And Code Sets Regulations?
The transactions and code sets regulations were enacted to reduce administrative costs and burdens in the health care industry by adopting and requiring the use of standardized, electronic transmission of administrative and financial data much like was done in the banking industry over ten years ago.
What Are "Transactions And Code Sets"?
Transactions refer to "Electronic Health Transactions," which include health claims, health plan eligibility, enrollment and disenrollment, payments for care and health plan premiums, claim status, first injury reports, coordination of benefits, and related transactions. Today, health providers and plans use many different electronic formats. Implementing a national standard will mean everyone will use one format, thereby "simplifying" and improving transaction efficiency nationwide.
Code sets refer to the "Standard Code Sets" that health organizations must adopt to use in all health transactions. For example, coding systems that describe diseases, injuries, and other health problems, as well as their causes, symptoms and actions taken must become uniform. All parties to any transaction will have to use and accept the same coding. Again, in the long run, this is intended to reduce mistakes, duplication of effort and costs. Fortunately, the code sets proposed as HIPAA standards are already used by many health plans, clearinghouses and providers, which should ease the transition.