HIPAA

1
HIPAA

• Health Insurance Portability and Accountability
  Act

2
What is it

• Signed into law on August 21, 1996
• Also known as the Kennedy-Kassenbaum Act
• Proposed due to the growing national concerns for
  health care reform

3
Some Basic Facts

• To provide health care coverage for all people,
  regardless of preexisting health conditions or
  layoff
• To combat waste, fraud and abuse in the health
  care system
• To protect medical records and other personal
  health information (PHI) and give patients new
  rights regarding the management of their PHI
• Administrative Simplification
• To establish precise and uniform standards for
  Electronic Data Interchange (EDI)
• To reduce the cost and improve the process of
  filing insurance claims

4
What are the HIPAA rules so far

• Privacy - final
• Transaction code Sets - final
• Employer ID - final
• Security - final
• National Provider ID - final
• Claims Attachments
• Enforcement final
• Individual ID on hold
• Health Plan ID

5
Who Must Comply

• Covered Entities
• Providers become a covered entity once they
  conduct any one transactions electronically.
• Clearinghouses are organizations that can be used
  to translate either to or from the standard
  format.
• Health Plans include an individual or group plan
• (e.g. Medi-Cal, Medicare, and the components
  of government agencies) who provide and pay for
  health care.

6
Who Else is Impacted

• Trading Partners- who exchange health information
  electronically.
• Business Associates- who conduct the transactions
  on behalf of covered entities.
• Users of Health Data- The data content will
  change in covered entities systems, therefore,
  others who receive and use this health data will
  have to react to new data content.

7
What Happens if You Dont Comply

• Risk Not getting paid
• Possible civil and criminal penalties

8
Where to Get Help

• Refer to Centers for Medicare Medicaid Services
  for the regulations at http//cms.hhs.gov/hipaa/
• California Office of Health Information
  Integrity, formerly the Office of HIPAA
  Implementation www.ohi.ca.gov