2.5 HIPAA Legislation and its Impact on Physician Practices

• The

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

number of rules, including: contains a –

HIPAA Electronic Transaction and Code Sets standards

– –

HIPAA Privacy Rule HIPAA Security Rule

– Final Enforcement Rule

2-15

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

2.5 HIPAA Legislation and its Impact on Physician Practices (Continued)

• HIPAA Electronic Transaction and Code Sets standards – Describe an electronic format that providers and health plans must use to send and receive health care transactions – The electronic transmission of data is called

electronic data interchange (EDI)

– Payment may be via

electronic funds transfer (EFT) 2-16

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

2.5 HIPAA Legislation and its Impact on Physician Practices (Continued)

• Claim Formats – The HIPAA-standard

X12-837 Health Care Claim

, or

837P

– The

CMS-1500 (08/05)

paper claim • The

National Provider Identifier (NPI)

is a ten position numerical identifier consisting of all numbers

2-17

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

2.5 HIPAA Legislation and its Impact on Physician Practices (Continued)

• HIPAA Privacy Rule – Protects individually identifiable health information – Mandates rules all covered entities must follow in protecting patients’ privacy – Information that can be used to find out a person’s identification, is referred to as

protected health information (PHI) 2-18

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

2.5 HIPAA Legislation and its Impact on Physician Practices (Continued)

• HIPAA Security Rule – Outlines safeguards to protect health information stored on a computer system or transmitted across computer networks –

Administrative safeguards:

the policies and procedures that protect electronic health information –

Physical safeguards:

the mechanisms required to protect electronic systems, equipment, and data –

Technical safeguards:

the automated processes used to protect data and control access to data • An

audit trail

is a report that shows who has accessed information and when

2-19

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

2.5 HIPAA Legislation and its Impact on Physician Practices (Continued)

• HIPAA in the Age of Health Information Technology – A

breach

is the acquisition, access, use, or disclosure of unsecured PHI in a manner not permitted under the HIPAA Privacy Rule

2-20

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

2.6 The HITECH Act’s Impact on Privacy and Security

• The HITECH Act introduced additional privacy and security regulations, including: – Breach notification – Monetary penalties – Advanced enforcement

2-21

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.