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 OVERVIEWThe Health Insurance Portability and Accountability Act was passed in 1996. The final rule took effect on April 14, 2001 and the compliance date for healthcare providers, clearinghouses and insurance companies was April 14, 2003. The first goal of the law was to simplify the administrative processes of the healthcare industry and reform the way payers conduct business. Currently an average of 26 cents of every dollar spent on healthcare goes towards administrative costs. To rectify this situation the Administrative Simplification section of HIPAA looks to make all administrative practices of the industry uniform. The goal is for providers to use the same submitter number for all insurance companies known as a universal identifier or unique health identifier. It is expected that this will be in a 10 digit numeric form. In addition, all electronic claims have to be in the same standardized format. Once these changes are in place insurance companies and providers will have a uniform format for healthcare administration. The second goal of HIPAA is to secure patients identifiable health information. With the exploding electronic technology available to providers it was deemed necessary to protect patients privacy rights. One thing is for sure, if you are using or are planning to contract your electronic data interchange to WNC Medical Claims you will not have to worry about the security of your patients information or abiding by the standard format set by HIPAA. We guarantee it! STANDARDIZATION OF EDI One part of the administrative simplification focuses on Electronic Data Interchange or the electronic transfer of information. HIPAA encourages the use of and states that these transfers must be in the standard format, which will be faster and more cost effective. Every healthcare professional in the United States is required to use the standards set for electronic transactions. They have the choice to either comply directly or can choose to use a service, like WNC Medical Claims to do it for them. Providers are not able to send non-standard electronic transactions unless they choose to contract with a clearinghouse that will convert their data into compliant data. Medicare and other healthcare payers are prohibited by law from accepting transactions (claims) that do not meet the new standards. WNC Medical Claims not only checks for errors made on such transfers but formats them so they are HIPAA compliant. SECURITY All medical records and other identifiable health information whether electronic, paper or oral is covered under HIPAA. It is the providers responsibility to protect this information for his or her patients. Patients must be educated of their rights to access, get copies and request amendments to their information. In addition, patients have a right to file a formal complaint to the U.S. Department of Health and Human Services if they feel their rights have been violated. Employees must be trained in the security of such information and there should be a privacy officer designated at each healthcare establishment. HIPAA states that the misuse of personal health information will be subject to civil and criminal penalties. Any entity required to follow HIPAA’s rules and does not will be subject to a $100.00 fine per violation, up to $25,000.00 per year. If there is a violation of privacy, congress states the criminal penalty will be up to $50,000.00 and one year in prison for obtaining or disclosing protected information, up to $100,000.00 and up to 5 years imprisonment for obtaining the information under “false pretenses” and finally up to $250,000.00 and up to 10 years prison time for obtaining and/or disclosing the information with intent to sell, have personal gain or harm another person. WNC Medical Claims has the highest level of security available. When you send your claims via our website it is protected from view from anyone else. Normally if you were to send a file from your computer it is sent in plain text therefore there is the potential that someone may intercept it. Our security has a 128-bit encryption level or in other words the highest encryption your computer browser will allow. HIPAA does not currently require a specific encryption level; it only states that the files must be encrypted. We use the best because we are at peak performance and we want you to be too. IN CONCLUSION The preceding has just been a small overview of what changes HIPAA has in store for the healthcare industry. To read the law for yourself, click here. |
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