Quarterly Meeting

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Quarterly Meeting

• HIPAA / Healthcare Industry
• Updates and News

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HIPAA Transactions

• A DSMO request was submitted to adopt the 835
  version 004050 as the HIPAA mandated
  implementation guide. This guide has no major
  programming impacts but the front matter has been
  expanded to help ease the frustration found in
  the implementation of this transaction.
• CMS has approved funding for a proposal by the
  Workgroup for Electronic Data Interchange (WEDi)
  Foundation and Empire Medicare Service to conduct
  a pilot of the electronic claim attachment. The
  pilot will use the X12N/HL7 implementation
  recommendations being proposed by the industry.
• NCPDP and AMCP spearhead collaborative efforts to
  finalize the Guiding Principles for Effective
  Electronic Messaging. This is a set of
  guidelines that, if widely accepted, could
  greatly increase the efficiency and quality of
  data presented to pharmacist during the claims
  submission process.
• Go to http//www.ncpdp.org/frame_new_htm for
  more information.

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HIPAA Security

• Draft Security Crosswalk The National Institute
  of Standards and Technology (NIST) has posted the
  DRAFT Special Publication 800-66 An Introductory
  Resource Guide for Implementing the Health
  Insurance Portability and Accountability Act
  (HIPAA) Security Rule for public comment. The
  guidance is intended to assist in identifying
  available NIST guidance which can provide useful
  reference material in addressing the HIPAA
  security standards. Go to http//csrc.nist.gov/p
  ublications/drafts.html
• Source http//www.cms.hhs.gov/hipaa/hipaa2/educa
  tion/default.asp

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Dont Miss the Next Meeting!November 12,
2004HIPAA Security Panel

• The Security panel is complete
• Anthem BCBS, Jeff Walco
• Bon Secours Hampton Roads, Laishy
  Williams-Carlson
• CMS Region III, Jeremy Willard
• Medical Society of Virginia, Jeff Buthe
• MGMA, Rob Tennant
• Virginia Medicaid
• WebMD, Wheeler Foster
• ProxyMed, Lonnie Hardin

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HIPAA Identifiers

• National Provider Identifier (NPI) Final Rule
  Published - The Final Rule adopting the HIPAA
  standard unique health identifier for health care
  providers was published in the Federal Register
  on January 23, 2004. Health care providers can
  begin applying for NPIs on the effective date of
  the final rule, which is May 23, 2005. All health
  care providers are eligible to be assigned NPIs
  health care providers who are covered entities
  must obtain and use NPIs. All HIPAA covered
  entities must use NPIs by the compliance dates
  (May 23, 2007 for all but small health plans May
  23, 2008 for small health plans).
• WEDi has a subworkgroups that are working on
  white papers with the following topics
• 1 - Overview/Summary of the NPI Rule
• 2 - NPI Registration Process
• 3 - Identification of Subparts for designation
  and use of NPI
• 4 - Implementation/Timing/Sequencing/Testing
• 5 - NPI Impact on Health Care Providers
• 6 - NPI Impact on Health Plans
• 7 - NPI Impact on Health Care Clearinghouses and
  vendors

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Healthcare Industry News

• Friday, August 20, 2004. Hospitalized man
  catches identity thief. Ex-lab tech pleads
  guilty to using private health files and credit
  cards. A former lab technician at the Seattle
  Cancer Care Alliance pleaded guilty yesterday to
  stealing the identity of a terminal cancer
  patient from confidential health records and
  using the information to go on a spending spree
  with fraudulent credit cards. Richard Gibson,
  42, of SeaTac is the first person in the United
  States to be convicted under privacy provisions
  of the federal Health Insurance Portability and
  Accountability Act HIPAA and faces 10 to 16
  months in prison. Original Source from
  Healthcare IT Weekly with links to Seattle
  ePaper. By PAUL SHUKOVSKY, SEATTLE
  POST-INTELLIGENCER REPORTER
• August 24, 2004 EMS purge seen in probe D.C. fire
  department officials plan to purge the leadership
  of the Emergency Medical Services division over
  the leak of confidential patient records that
  already has forced the ousting of the agency's
  medical director. Original Source from
  Healthcare informatics to DC ePaper article By
  Matthew Cella, THE WASHINGTON TIMES

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Pending Regulations
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Additional Resources

• Free Fax Back Services. The CMS Southern
  Consortiums Achieving Compliance Together Team
  has developed a HIPAA resource in an effort to
  reach those without internet/email access! Have
  your fax number handy and call this number
  800-874-5894
• Select Option 1 for the starter set HIPAA
  information, resources, and transactions
  checklist, then follow the prompts. It's that
  easy! Other documents are also available (for
  example, information on Medicare's free billing
  software and a HIPAA glossary).
• Source http//www.cms.hhs.gov/hipaa/hipaa2/educa
  tion/HIPAATraining.aspHIPAATraining

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Additional Resources

• Free CMS HIPAA Training via Webcast The CMS
  Southern Consortiums Achieving Compliance
  Together Team has developed a series of HIPAA
  presentations. They can be accessed via the
  Internet and there is no cost to you. To access
  these presentations, simply click on the
  following link http//www.eventstreams.com/cms/tm
  _001/ You can choose any of the following
  presentations
• HIPAA Message to Providers from the Southern
  Consortium Administrator
• HIPAA Basics
• Provider Steps to Getting Paid under HIPAA
• HIPAA Security
• CMS Enforcement of the TCS
• 837 Professional Claim
• 837 Institutional Claim
• Source http//www.cms.hhs.gov/hipaa/hipaa2/educa
  tion/default.asp

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Contacts

• Steve Farmer
• Richmond, VA
• [phone]
• stephen.farmer
• _at_anthem.com

• Ruth Tucci-Kaufhold
• Glen Allen, VA
• [phone]
• ruth.tucci-kaufhold_at_unisys.com

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