Health Insurance Portability and Accountability Act
What is HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA)
of 1996 contains the following three major provisions:
- Medicare Integrity Program/Fraud and Abuse
- Administrative Simplification
The portability provisions, implemented in 1997, provide
available and renewable health coverage and remove the pre-existing
condition clause, under defined guidelines, for individuals
changing employers and health plans.
The Medicare Integrity Program (MIP) implemented in 1998,
guarantees that the Health Care Financing Administration (HCFA) has
a funding source for integrity activities and expands its authority
to hire anti-fraud contractors.
The administrative simplification provision implemented standard
transaction and code sets, identifiers, security, and privacy rules
across the health care industry.
Administrative Simplification Requirements of HIPAA
The four major requirements of administrative simplification are
the following (click the hyperlinked text for more information
about a particular regulation):
The requirements promote electronic transactions, regulate
format and content standards, and make conforming security and
privacy standards. The Transaction and Code Set final rule
was published in the Federal Register August 17, 2000, and became
effective October 16, 2000. The rule required full compliance
for large health plans (including federal and state programs),
clearinghouses, and providers by October 16, 2002.
Entities Affected by the HIPAA Administrative Simplification
All of the following entities are affected by the HIPAA
administration simplification requirements:
- All health plans, including Medicaid, Medicare, and commercial
- Providers that transmit or store health information
- Health care clearinghouses
It is important to obtain a copy of this rule
and review it thoroughly to determine the effects HIPAA will have
on your organization's systems and business processes. The
final rule defines the requirements and standards that you must
implement to comply with HIPAA regulations. This rule can be
accessed at: http://www.access.gpo.gov/su_docs/fedreg/a000817c.htmlF