Time to Learn HIPAA Administrative Simplification

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• Health Insurance Portability and Accountability
  Act of 1996
• ISC Expo
• October 16 17, 2002
• John Wagner
• Governors Office of Technology

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Time to Learn about Administrative
Simplification
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Health Insurance Portability and Accountability
ActHIPAA Public Law 104-191
To improve the efficiency and effectiveness of
the health care system.
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And Why are We Doing This?

• To improve the efficiency effectiveness of the
  health care system by standardizing the format
  content and data elements in electronic health
  care transactions
• Assure portability continuity of healthcare
• Combat fraud and abuse
• Promote medical savings account
• Improve Long Term Care access coverage
• Simplify the administration of health care

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Biggest Problems for States

• Implementing New Security Procedures
• Implementing New Privacy Procedures
• Implementing Transactions Code Sets
• Renovate? Replace? Translators? Clearinghouse?
• Multiple Waves of Implementations
• End-to-End Testing ( Multiple Waves)

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And More Big Problems for States

• Not Enough Time for Implementation(s)
• Contracts with Data Exchange Partners
• Penalties
• Resources Money Personnel
• Selecting Translators Chasing a Moving Target

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• HIPAA standards will regulate
• Format
• Privacy
• Security
• Content
• Any health care entity public or private that
  creates, stores or transmits health care data in
  any format, must comply within 2 years of
  standards adoption (there are exceptions for
  certain plans based on size).

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HIPAA EFFECTS THE ENTIRE HEALTH CARE INDUSTRY!

• Healthcare entities include
• Health Care Plans
• Health Care Providers
• Clearinghouses
• Business Associates
• Trading Partners

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• We are in this together and everything is
  connected

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The Thigh Bones Connected to the Knee Bone

• TITLE II Preventing Health Care Fraud and Abuse
• Subtitle A Fraud and Abuse Control Program
• Subtitle B Revisions to Current Sanctions for
  Fraud and Abuse
• Subtitle C Data Collection
• Subtitle D Civil Monetary Penalties
• Subtitle E Revisions to Criminal Law
• Subtitle F Administrative Simplification
• Subtitle G Duplication and Coordination of
  Medicare-Related Plans
• Subtitle H Patent Extension

Title II
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The Knee Bones Connected to the Leg Bone


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Questions for States

• Who is responsible for HIPAA compliance?
• What is the States timetable?
• Which implementation solution is best for the
  State?
• What options are available in the limited time
  available?
• How do we address Privacy Security?
• How do we address TCS requirements?

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Standards for Electronic Transactions

• Claim and encounter
• Payment and remittance advice
• Third Party Liability (claim format)
• Claim status inquiry and response
• Enrollment and disenrollment in a health plan
• Eligibility (inquiry and response)
• Health plan premium payments
• Authorization for service request and response

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Standards, Rules, and X12 Cross Reference
Standard Transaction Claim -Professional Claim -
Institutional Claim - Dental Remittance Claim
Status Enrollment Eligibility Premium
Payment Referral First Injury Report Attachments
Implementation Guide (v.4010) X098 X096 X096 X091
X093 X095 X092 X061 X094
45 CFR Part 142 K, M K, M K, M L N O P Q R
X12 Standard 837 837 837 835 276 and 277 834 270
and 271 820 278
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Implementation Strategies for Transaction Code
Sets

• OPTIONS
• Replace Systems
• Renovate Systems
• Install EDI Translators
• Use Clearinghouses
• Combination

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More Questions for States

• Criteria for validating data conversions and
  mapping when using translators and Clearinghouses
• How to deal with more and more delays (get
  started now with X12 assessment?)
• How can we standardize Policy and Security
• Where do we get the money and resources?

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Quick Review
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• What is the purpose of HIPAA?
• To improve the efficiency and effectiveness of
  the health care system by standardizing the
  format content and data elements in electronic
  health care transactions and provide privacy
  protection for protected health information.

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Who must implement HIPAA?

• Any health care entity public or private that
  creates, stores or transmits health care data in
  any format.

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Health care entities include

• Health Care Plans
• Health Care Providers
• Clearinghouses
• Business Associates
• Trading Partners

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What is covered by HIPAA?

• You!!
• Personal Health Information (PHI) is protected by
  HIPAA

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• What are the components that have been identified
  by DHHS for implementation of HIPAA
  Administrative Simplification?
• Transaction and Code Sets
• Privacy
• Security
• Training

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• Is information available on the Web about HIPAA?
• Yes, information can be found at
• WWW.WVDHHR.ORG/HIPAA

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• Where can I ask questions
  regarding HIPAA?
• The WV HIPAA Project Management Office is
  staffed and ready to answer your questions. You
  may reach the PMO at 558-5164.

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• Dont let this be you

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• Or you could be getting a visit
• from this guy!

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Where To Go For More HIPAA Information
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Questions?

• HIPAA PROJECT OFFICE
• 558-5164
• WWW.WVDHHR.ORG/HIPAA

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Good Luck!

• Keep Reading!
• Talley Ho!