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Hipaa compliance understanding its applicability

HIPAA Compliance: Understanding Its Applicability

Hipaa compliance understanding its applicability

What is HIPAA?

  • HIPAA: Health Insurance Portability and Accountability Act

  • It was passed by Congress in 1996

  • It includes requirements for:

    • Transfer and continuation of health insurance coverage for millions of American workers and their families when they change or lose their jobs

    • Reducing healthcare fraud and waste

    • Industry-wide standards for healthcare information on electronic billing and other processes

    • The protection and confidential handling of protected health information

      Whom Does HIPAA Apply To?

      Applies to:

      • Health Plans

      • Healthcare Providers

      • Healthcare Clearinghouses

Hipaa applicability health plans
HIPAA Applicability – Health Plans

  • For health plans, HIPAA rules apply to individual and group plans that provide or pay the cost of medical care.

  • Health plans include:

    • health, dental, vision, and prescription drug insurers

    • health maintenance organizations (“HMOs”)

    • Medicare, Medicaid and Medicare supplement insurers

    • Long-term care insurers

    • Employer-sponsored group health plans

    • Government and church-sponsored health plans,

    • Multi-employer health plans

Hipaa applicability healthcare providers
HIPAA Applicability – Healthcare Providers

HIPAA rules apply to every healthcare provider, regardless of size, who electronically transmits health information in connection with the following transactions:

  • claims,

  • benefit eligibility inquiries,

  • referral authorization requests, or

  • other transactions for which HHS has established standards under the HIPAA Transactions Rule

    Healthcare providers include:

  • All “providers of services” (e.g., institutional providers such as hospitals) and

  • “providers of medical or health services” (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for healthcare

Hipaa applicability healthcare clearinghouses
HIPAA Applicability – Healthcare Clearinghouses

  • Healthcare clearinghouses are entities that process nonstandard information they receive from another entity into a standard format or data content, or vice versa.

  • Healthcare clearinghouses include:

    • billing services,

    • repricing companies,

    • community health management information systems, and

    • value-added networks and switches if these entities perform clearinghouse functions.

Hipaa applicability business associates
HIPAA Applicability – Business Associates

  • According to HIPAA rules, a business associate is a third party person or organization that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involve the use or disclosure of individually identifiable health information.

  • Business associate functions or activities on behalf of a covered entity include:

    • claims processing,

    • data analysis,

    • utilization review, and

    • Billing

  • Business associate services to a covered entity are limited to:

    • legal,

    • actuarial,

    • accounting,

    • consulting,

    • data aggregation,

    • management,

    • administrative,

    • accreditation, or

    • financial services

Hipaa compliance understanding its applicability

Want to learn more about HIPAA, its requirements and best practices to comply with them? ComplianceOnline webinars and seminars are a great training resource. Check out the following links:

  • How to examine security policies, practices, and risk issues to comply with HIPAA

  • How to use social media and texting without breaking HIPAA rules

  • How to Conduct risk analysis to comply with HIPAA

  • HIPAA/HITECH Assessment for Healthcare Business Associates

  • How to comply with HIPAA Omnibus Rule

  • Understanding new rules and responsibilities of Privacy Officer under HIPAA

  • HIPAA Security and Breach Rule Compliance