HIPAA 101: The Basics of HIPAA Administrative Simplification

00:43:06
https://www.youtube.com/watch?v=ahEW1xEKz0Y

Ringkasan

TLDRThe video outlines the basics of HIPAA's administrative simplification provisions, focusing on electronic healthcare transactions and code sets standards. It covers the history of HIPAA, compliance requirements for covered entities, and the importance of standardization in healthcare transactions. The video also discusses enforcement of HIPAA rules, compliance deadlines, and available resources for further information. Key areas include electronic transactions, unique identifiers, privacy, and security standards, emphasizing the need for healthcare providers to comply with these regulations to ensure efficient and secure handling of health information.

Takeaways

  • 📜 HIPAA was enacted in 1996 to protect health information.
  • 💻 Covered entities must comply with electronic transaction standards.
  • 🔍 Compliance deadlines vary for different provisions of HIPAA.
  • 📅 Key compliance dates include April 14, 2003, and October 16, 2003.
  • 🔒 HIPAA mandates privacy and security standards for health information.
  • 📞 Resources like the CMS HIPAA website provide valuable information.
  • 🛠️ Designated standards maintenance organizations help maintain HIPAA standards.
  • 📊 Direct data entry (DDE) allows providers to input data directly into health plans.
  • 💡 Understanding your status as a covered entity is crucial for compliance.
  • ⚖️ Non-compliance can lead to significant penalties.

Garis waktu

  • 00:00:00 - 00:05:00

    The program introduces HIPAA administrative simplification, focusing on electronic healthcare transactions and code sets standards. It aims to clarify HIPAA's history, benefits, compliance requirements, and enforcement mechanisms, while addressing common questions about HIPAA.

  • 00:05:00 - 00:10:00

    HIPAA, enacted in 1996, aims to protect healthcare benefits and standardize transactions, enhancing efficiency and reducing costs. The second title of HIPAA focuses on administrative simplification, which includes electronic transactions, unique identifiers, privacy, and security standards.

  • 00:10:00 - 00:15:00

    The administrative simplification standards apply to healthcare clearinghouses, health plans, and certain healthcare providers. A transaction is defined as the electronic exchange of information for healthcare-related activities, with specific standards established for various types of transactions.

  • 00:15:00 - 00:20:00

    HIPAA's provisions were implemented through regulations with varying compliance deadlines. The final rule for electronic transactions was issued in 2000, with compliance required by 2002, later extended for some entities. HIPAA does not mandate electronic claims submission but requires compliance with standards if electronic transactions are conducted.

  • 00:20:00 - 00:25:00

    Small healthcare providers are not exempt from HIPAA; they are considered covered entities if they transmit designated transactions electronically. Compliance deadlines for privacy provisions and unique identifiers are outlined, with specific dates for small health plans.

  • 00:25:00 - 00:30:00

    The final rule for security standards was published in 2003, requiring covered entities to implement security procedures for electronic health information. Compliance dates vary for small health plans, and resources for compliance are available on the CMS website.

  • 00:30:00 - 00:35:00

    Covered entities must assess their status, identify communication methods, and evaluate business processes for HIPAA compliance. Testing and coordination with trading partners are crucial steps, along with establishing agreements for HIPAA-compliant transactions.

  • 00:35:00 - 00:43:06

    CMS enforces HIPAA provisions, focusing on compliance and providing technical assistance. Penalties for non-compliance include civil and criminal penalties, with an emphasis on helping entities achieve compliance before imposing penalties.

Tampilkan lebih banyak

Peta Pikiran

Video Tanya Jawab

  • What is HIPAA?

    HIPAA stands for the Health Insurance Portability and Accountability Act, which was enacted in 1996 to protect healthcare information and standardize electronic healthcare transactions.

  • Who is considered a covered entity under HIPAA?

    Covered entities include healthcare providers who conduct electronic transactions, health plans, and healthcare clearinghouses.

  • Do I have to submit healthcare claims electronically?

    HIPAA does not require electronic submission of claims, but if you conduct certain transactions electronically, you must use HIPAA standards.

  • What are the compliance deadlines for HIPAA?

    Key compliance deadlines include April 14, 2003, for privacy requirements, and October 16, 2003, for electronic transactions and code sets.

  • What are the penalties for non-compliance with HIPAA?

    Penalties can include civil monetary fines and criminal penalties for knowingly violating HIPAA rules.

  • How can I determine if I am a covered entity?

    You can determine if you are a covered entity by assessing if you conduct electronic transactions as defined by HIPAA.

  • What resources are available for HIPAA compliance?

    Resources include the CMS HIPAA website, HIPAA hotlines, and provider readiness checklists.

  • What is the role of designated standards maintenance organizations (DSMO)?

    DSMO are organizations that maintain and develop standards for HIPAA compliance.

  • What is direct data entry (DDE)?

    DDE refers to entering data directly into a health plan's computer system using terminals or browser screens.

  • What is the purpose of HIPAA's administrative simplification provisions?

    The provisions aim to streamline healthcare transactions, reduce costs, and protect patient information.

Lihat lebih banyak ringkasan video

Dapatkan akses instan ke ringkasan video YouTube gratis yang didukung oleh AI!
Teks
en
Gulir Otomatis:
  • 00:00:00
    [Music]
  • 00:00:16
    hello and welcome to the Centers for
  • 00:00:19
    Medicare and Medicaid Services program
  • 00:00:21
    on the basics of HIPAA administrative
  • 00:00:24
    simplification I'm Valerie Hart and I'm
  • 00:00:27
    joined by John Young and will be your
  • 00:00:29
    guides as we review the information you
  • 00:00:32
    need to know about HIPAA and complying
  • 00:00:34
    with its administrative simplification
  • 00:00:36
    provisions specifically the electronic
  • 00:00:39
    healthcare transaction and code sets
  • 00:00:41
    standards this program is designed to
  • 00:00:44
    help you understand the history of HIPAA
  • 00:00:45
    and its benefits for you unsure whether
  • 00:00:48
    you're a covered entity will show you
  • 00:00:50
    how to find out then we'll cover the
  • 00:00:52
    standards that have been adopted for
  • 00:00:54
    electronic transactions and code sets
  • 00:00:56
    you'll find out why the designated
  • 00:00:58
    standards maintenance organizations may
  • 00:01:00
    be important to you you will also learn
  • 00:01:02
    about some of the steps you need to take
  • 00:01:04
    become compliant with the administrative
  • 00:01:05
    simplification provisions of HIPAA we'll
  • 00:01:08
    also touch on how HIPAA rules and
  • 00:01:10
    deadlines will be enforced we'll also
  • 00:01:12
    share the answers to some of the HIPAA
  • 00:01:14
    questions that we have received and show
  • 00:01:16
    you how to get more information about
  • 00:01:18
    HIPAA
  • 00:01:20
    you
  • 00:01:24
    Congress passed the Health Insurance
  • 00:01:26
    Portability and Accountability Act in
  • 00:01:29
    1996 in addition to creating consumer
  • 00:01:33
    protection for healthcare benefits the
  • 00:01:35
    portability part of HIPAA Hippo will
  • 00:01:38
    standardize financial and administrative
  • 00:01:40
    health transactions for the public and
  • 00:01:43
    private sectors increased speed and
  • 00:01:45
    efficiency cut the cost of delivering
  • 00:01:48
    health care services and set minimum
  • 00:01:52
    standards of protection for the storage
  • 00:01:54
    use and transfer of protected health
  • 00:01:57
    information
  • 00:01:58
    in short HIPAA puts the force of law
  • 00:02:01
    behind the adoption of standards the
  • 00:02:03
    HIPAA statute has five titles the second
  • 00:02:07
    title contains the administrative
  • 00:02:08
    simplification provisions and is the one
  • 00:02:11
    we will focus on today there are four
  • 00:02:14
    main areas that comprise administrative
  • 00:02:17
    simplification the first is electronic
  • 00:02:20
    transactions and code sets HIPAA adopts
  • 00:02:23
    and requires the use of uniform national
  • 00:02:25
    standards and requirements for
  • 00:02:27
    conducting electronic health care
  • 00:02:29
    transactions the second area is the
  • 00:02:33
    unique identifier HIPAA requires
  • 00:02:36
    establishing and assigning a standard
  • 00:02:38
    identifier that providers health plans
  • 00:02:41
    and employers will use for every
  • 00:02:43
    electronic healthcare transaction the
  • 00:02:46
    third is privacy under HIPAA covered
  • 00:02:49
    entities must implement standards to
  • 00:02:52
    protect and guard against the misuse of
  • 00:02:55
    individually identifiable health
  • 00:02:57
    information the final area is security
  • 00:03:01
    HIPAA addresses how electronic health
  • 00:03:04
    information is stored transmitted and
  • 00:03:06
    accessed
  • 00:03:07
    [Music]
  • 00:03:13
    the administrative simplification
  • 00:03:15
    standards adopted by the Secretary of
  • 00:03:18
    the Department of Health and Human
  • 00:03:19
    Services under HIPAA applies to all
  • 00:03:21
    health care clearing houses all health
  • 00:03:24
    plans those health care providers that
  • 00:03:27
    conduct certain transactions in
  • 00:03:28
    electronic form or use a billing service
  • 00:03:31
    to conduct transactions on their behalf
  • 00:03:33
    if you meet one or more of these
  • 00:03:35
    criteria you are a covered entity and
  • 00:03:38
    must comply with the administrative
  • 00:03:39
    simplification requirements of HIPAA we
  • 00:03:42
    have mentioned transactions a lot
  • 00:03:43
    exactly what is a transaction a
  • 00:03:46
    transaction is the electronic
  • 00:03:48
    transmission of information between two
  • 00:03:50
    parties to carry out financial or
  • 00:03:52
    administrative activities related to
  • 00:03:54
    health care electronic transaction
  • 00:03:57
    standards have been developed for the
  • 00:03:59
    following exchanges of information
  • 00:04:01
    healthcare claims or equivalent
  • 00:04:03
    encounter information healthcare payment
  • 00:04:06
    and remittance advice healthcare claim
  • 00:04:09
    status eligibility inquiry referral
  • 00:04:13
    certification and authorization
  • 00:04:15
    enrollment and disenrollment in the
  • 00:04:18
    health plan health plan premium payment
  • 00:04:21
    coronation of benefits claims attachment
  • 00:04:25
    standards forthcoming and first report
  • 00:04:28
    of injury standards forthcoming what do
  • 00:04:32
    we mean by electronic the term
  • 00:04:34
    electronic is used to describe moving
  • 00:04:37
    healthcare data via the internet and
  • 00:04:39
    extranet leased lines dial-up lines such
  • 00:04:44
    as direct data entry or dde private
  • 00:04:48
    networks point of service and health
  • 00:04:51
    data that is physically moved from one
  • 00:04:53
    location to another using magnetic tape
  • 00:04:56
    disk or CD media faxes sent using a
  • 00:05:00
    dedicated fax machine as opposed to
  • 00:05:02
    faxing from a computer and voice
  • 00:05:03
    response units on phones are not subject
  • 00:05:06
    to the transaction standards but may
  • 00:05:08
    have to meet privacy and security
  • 00:05:10
    standards now let's catch up with
  • 00:05:12
    another special term and define direct
  • 00:05:15
    data entry or dde in some more detail
  • 00:05:18
    with dde remote user keys data directly
  • 00:05:21
    into a health plans computer using dumb
  • 00:05:24
    terminals or computer browser screens
  • 00:05:27
    health plans can give providers the
  • 00:05:28
    option to use dde but are not obligated
  • 00:05:31
    to do so
  • 00:05:39
    in this segment we get back to more of
  • 00:05:41
    the details of administrative
  • 00:05:42
    simplification
  • 00:05:43
    although HIPAA was enacted in 1996 each
  • 00:05:47
    of the provisions of administrative
  • 00:05:49
    simplification are set in motion through
  • 00:05:51
    the issuing of proposed and final
  • 00:05:53
    regulations thus each part of
  • 00:05:55
    administrative simplification has
  • 00:05:57
    different effective dates and different
  • 00:05:59
    compliance deadlines we'll review them
  • 00:06:02
    in the next section the final rule for
  • 00:06:05
    electronic transactions and code set
  • 00:06:07
    standards was issued in August 2000
  • 00:06:10
    compliance with this rule was required
  • 00:06:12
    by October 16th 2002 the large health
  • 00:06:15
    plans health care providers and health
  • 00:06:18
    care clearing houses however Congress
  • 00:06:21
    realized that many covered entities
  • 00:06:23
    would not be ready to comply with that
  • 00:06:25
    date so in December of 2001 it passed
  • 00:06:29
    legislation that became public law 1:07
  • 00:06:32
    - 1:05 also known as the administrative
  • 00:06:36
    simplification Compliance Act or Aska
  • 00:06:38
    for short which amended HIPAA and
  • 00:06:41
    granted a one-year compliance extension
  • 00:06:43
    to October 16th 2003 under certain
  • 00:06:46
    conditions that extension was available
  • 00:06:49
    to covered entities scheduled to become
  • 00:06:52
    compliant in 2002 provided the covered
  • 00:06:55
    entity submitted a compliance extension
  • 00:06:57
    plan to CMS by October 15 2002 small
  • 00:07:02
    health plans with receipts of less than
  • 00:07:04
    5 million dollars have always had until
  • 00:07:06
    October 16 2003 to comply and the
  • 00:07:09
    compliance date was not affected by the
  • 00:07:11
    extension covered entities that filed
  • 00:07:15
    for an extension are required to begin
  • 00:07:17
    their internal testing by April 16 2003
  • 00:07:21
    does HIPAA require that I submit my
  • 00:07:23
    healthcare claims electronically
  • 00:07:26
    HIPAA does not require that you submit
  • 00:07:28
    healthcare claims electronically what it
  • 00:07:31
    does require is that if you conduct
  • 00:07:33
    certain transactions electronically you
  • 00:07:35
    must use the HIPAA standards and there's
  • 00:07:38
    another important element of Aska it
  • 00:07:41
    requires that most Medicare claims
  • 00:07:43
    submitted after October 16 2003 be
  • 00:07:47
    submitted electronically there will be
  • 00:07:49
    exceptions to this requirement for
  • 00:07:52
    example you
  • 00:07:53
    we'll be able to continue to submit
  • 00:07:54
    paper claims if there is no method
  • 00:07:56
    available for submitting them
  • 00:07:58
    electronically also regardless of
  • 00:08:01
    whether an electronic claim format is
  • 00:08:03
    available small providers of services or
  • 00:08:06
    supplies can continue to use paper small
  • 00:08:10
    providers are defined by Aska as a
  • 00:08:12
    physician practitioner facility or
  • 00:08:15
    supplier other than provider of services
  • 00:08:17
    with fewer than 10 full-time equivalent
  • 00:08:20
    employees or a provider of services with
  • 00:08:24
    fewer than 25 full-time equivalent
  • 00:08:26
    employees there may be additional
  • 00:08:29
    exceptions regulations clarifying the
  • 00:08:32
    exceptions to the Medicare electronic
  • 00:08:34
    billing requirements will be issued if
  • 00:08:36
    you are a provider and believe you
  • 00:08:39
    qualify for an exception you should
  • 00:08:41
    continue to build Medicare via paper
  • 00:08:44
    there's currently no mechanism in place
  • 00:08:46
    to request a waiver of these
  • 00:08:48
    requirements so please be patient and
  • 00:08:50
    wait for the regulations to be issued
  • 00:08:53
    it's time to hear one of the HIPAA
  • 00:08:55
    questions that we received I'm a small
  • 00:08:58
    healthcare provider
  • 00:08:59
    I've heard that I'm excluded from HIPAA
  • 00:09:00
    is that true no small providers are not
  • 00:09:04
    excluded from HIPAA the size of the
  • 00:09:07
    healthcare providers office does not
  • 00:09:09
    exempt them from HIPAA if a healthcare
  • 00:09:12
    provider transmits any of the designated
  • 00:09:14
    transactions electronically they are
  • 00:09:16
    considered a covered entity and are
  • 00:09:19
    subject to the administrative
  • 00:09:20
    simplification provisions of HIPAA
  • 00:09:23
    Thanks
  • 00:09:24
    now let's move on to the compliance
  • 00:09:27
    dates for the other key components of
  • 00:09:29
    administrative simplification the final
  • 00:09:32
    rule for HIPAA privacy was published in
  • 00:09:34
    December of 2000 with final
  • 00:09:36
    modifications published August 14th 2002
  • 00:09:39
    they set the compliance date of April
  • 00:09:42
    14th 2003 for all covered entities
  • 00:09:44
    except small health plans remember even
  • 00:09:48
    if you got the one-year extension for
  • 00:09:49
    meeting the electronic transactions and
  • 00:09:51
    code sets requirements you still must
  • 00:09:54
    meet all deadlines for compliance with
  • 00:09:56
    the deadlines for the privacy provisions
  • 00:09:58
    or any of the other HIPAA administrative
  • 00:10:01
    simplification provisions April 14th
  • 00:10:04
    2004 is the privacy complying
  • 00:10:07
    stay for small health plans the standard
  • 00:10:10
    unique identifiers mandated by HIPAA
  • 00:10:13
    include the following the national
  • 00:10:15
    employer identifier the national
  • 00:10:18
    provider identifier and the national
  • 00:10:21
    health plan identifier the final
  • 00:10:23
    regulation said specify the national
  • 00:10:25
    employer identifier were published in
  • 00:10:28
    May 2002 the rules adopt the employer
  • 00:10:31
    identification number or ein an existing
  • 00:10:35
    identifier already issued by the
  • 00:10:37
    Internal Revenue Service as the national
  • 00:10:40
    employer identifier for use in
  • 00:10:42
    healthcare transactions the use of this
  • 00:10:45
    identifier will improve the Medicare and
  • 00:10:47
    Medicaid programs and the effectiveness
  • 00:10:50
    and efficiency of the health care
  • 00:10:51
    industry in general by simplifying the
  • 00:10:54
    administration of the system and
  • 00:10:56
    enabling the efficient electronic
  • 00:10:59
    transmission of certain health
  • 00:11:00
    information all covered entities accept
  • 00:11:04
    small health plans must comply with the
  • 00:11:07
    national employer identifier standards
  • 00:11:09
    by July 30th 2004 small health plans
  • 00:11:13
    must comply by August 1st 2005 as of
  • 00:11:18
    December 2002 the final regulations for
  • 00:11:21
    the national provider identifier are
  • 00:11:23
    still pending and the rule for the
  • 00:11:25
    national health plan identifier has not
  • 00:11:28
    been released
  • 00:11:29
    On February 20th 2003 the Department of
  • 00:11:33
    Health and Human Services published the
  • 00:11:34
    final rule for security standards for
  • 00:11:36
    electronic protected health care
  • 00:11:38
    information this rule specifies a series
  • 00:11:41
    of administrative technical and physical
  • 00:11:43
    security procedures for covered entities
  • 00:11:46
    to use to assure the confidentiality of
  • 00:11:48
    electronic protected health information
  • 00:11:51
    the security compliance dates are April
  • 00:11:53
    21st 2005 in April 21st 2006 for small
  • 00:11:58
    health plans please visit the CMS
  • 00:12:01
    website for current information about
  • 00:12:02
    security that site is WW CMS HHS govt /
  • 00:12:11
    HIPAA slash HIPAA - will provide a list
  • 00:12:15
    with this address and other helpful web
  • 00:12:17
    addresses at the end of the program
  • 00:12:20
    or we move on let's review each of the
  • 00:12:22
    three covered entity categories in more
  • 00:12:24
    detail to help you determine if you are
  • 00:12:26
    a covered entity let's start with
  • 00:12:29
    providers how do you know if you or your
  • 00:12:32
    business is a covered healthcare
  • 00:12:33
    provider all healthcare providers that
  • 00:12:36
    conduct any electronic transactions for
  • 00:12:39
    which the Secretary of the Department of
  • 00:12:40
    Health and Human Services has adopted
  • 00:12:42
    standards are covered entities this
  • 00:12:45
    includes providers who use a billing
  • 00:12:47
    service or a clearinghouse this includes
  • 00:12:50
    hospitals clinics nursing homes
  • 00:12:52
    positions suppliers and others that
  • 00:12:56
    furnish bill or receive payments for
  • 00:12:58
    health care services in the normal
  • 00:13:00
    course of business if you use another
  • 00:13:03
    entity such as a clearinghouse to
  • 00:13:05
    conduct covered transactions in
  • 00:13:07
    electronic form on your behalf you are
  • 00:13:09
    considered to be conducting the
  • 00:13:11
    transaction in electronic form and thus
  • 00:13:13
    you are a covered entity now how do you
  • 00:13:17
    determine if your business is a covered
  • 00:13:19
    healthcare clearinghouse if your
  • 00:13:22
    business processes or facilitates the
  • 00:13:24
    processing of health information from
  • 00:13:26
    non-standard formats to standard formats
  • 00:13:29
    and vice versa you are considered a
  • 00:13:32
    clearinghouse and thus a covered entity
  • 00:13:34
    clearinghouse services may be provided
  • 00:13:36
    by many types of organizations including
  • 00:13:40
    billing services repricing companies or
  • 00:13:43
    in some cases banks finally how do you
  • 00:13:46
    determine if your private benefit plan
  • 00:13:48
    or government-funded program is a health
  • 00:13:50
    plan a health plan is broadly defined as
  • 00:13:53
    an individual or group plan that
  • 00:13:55
    provides or pays the cost of medical
  • 00:13:57
    care for private benefit plans in
  • 00:14:00
    general it is considered health plan if
  • 00:14:02
    the plan is health insurance issuer a
  • 00:14:05
    group health plan and insurer of a
  • 00:14:08
    Medicare supplemental policy an HMO or a
  • 00:14:12
    multi-employer welfare benefit plan
  • 00:14:15
    long-term care policies in addition to
  • 00:14:17
    other policies are covered however
  • 00:14:20
    nursing home fixed and M&D policies are
  • 00:14:22
    not there is an important exception to
  • 00:14:25
    that definition if the plan is a group
  • 00:14:28
    health plan that has fewer than 50
  • 00:14:30
    participants
  • 00:14:31
    and is self-administered then it is not
  • 00:14:34
    considered a health plan remember HIPPA
  • 00:14:38
    gave small health plans an additional
  • 00:14:40
    year to comply with the HIPAA
  • 00:14:42
    transaction and code set standards so
  • 00:14:45
    what exactly is a small plan a small
  • 00:14:48
    health plan is defined as having annual
  • 00:14:50
    receipts of five million dollars or less
  • 00:14:53
    annual receipts means total income or
  • 00:14:56
    gross income plus cost of goods sold as
  • 00:14:59
    these terms are defined or report it on
  • 00:15:01
    IRS federal tax return forms health
  • 00:15:05
    plans that do not report receipts to the
  • 00:15:07
    IRS such as ERISA group health plans
  • 00:15:09
    exempt from filing income tax returns to
  • 00:15:12
    use proxy measures to determine their
  • 00:15:14
    annual receipts fully insured health
  • 00:15:17
    plans should use the amount of total
  • 00:15:19
    premiums which they paid for health
  • 00:15:21
    insurance benefits during the plans last
  • 00:15:23
    full fiscal year self-insured plans both
  • 00:15:27
    fund it and unfund it to use the total
  • 00:15:30
    amount paid for healthcare claims by the
  • 00:15:31
    employer plan sponsor or benefit fund as
  • 00:15:35
    applicable to their circumstances on
  • 00:15:37
    behalf of the plan during the plans last
  • 00:15:39
    fiscal year these plans that provide
  • 00:15:42
    health benefits through a mix of
  • 00:15:44
    purchased insurance and self insurance
  • 00:15:46
    combined the proxy measures to determine
  • 00:15:49
    the total annual receipts finally most
  • 00:15:53
    government funded programs are
  • 00:15:54
    considered health plans this includes
  • 00:15:57
    Medicare Medicare plus choice Medicaid
  • 00:16:01
    state children's health insurance
  • 00:16:02
    program TRICARE Indian Health Service
  • 00:16:06
    veteran's health care program and the
  • 00:16:09
    Federal Employees Health Benefit program
  • 00:16:11
    however government-funded programs other
  • 00:16:15
    than those listed above are not health
  • 00:16:17
    plans if their primary purpose is other
  • 00:16:20
    than paying for or providing care or if
  • 00:16:23
    their principal activity is the direct
  • 00:16:25
    provision of health care or making
  • 00:16:28
    grants to fund health care remember if
  • 00:16:31
    you are covered entity you are
  • 00:16:34
    responsible for complying with the rules
  • 00:16:36
    and regulations of administrative
  • 00:16:38
    simplification including meeting all
  • 00:16:40
    compliance deadlines of each of the
  • 00:16:43
    provisions
  • 00:16:45
    if you still have questions about how to
  • 00:16:46
    determine if you are covered entity you
  • 00:16:49
    can visit the CMS website at the address
  • 00:16:52
    on the screen and follow the covered
  • 00:16:54
    entity flow chart decision tool okay so
  • 00:16:59
    let's say you've determined that you are
  • 00:17:00
    covered entity in segment two we briefly
  • 00:17:04
    touched on the HIPAA transactions now
  • 00:17:07
    let us clarify the transactions and code
  • 00:17:09
    set standards that covered entities must
  • 00:17:11
    use let's listen to another HIPAA
  • 00:17:16
    question on the health care provider am
  • 00:17:19
    I allowed to submit claims both
  • 00:17:21
    electronically and by paper under HIPAA
  • 00:17:24
    a provider has the option for any
  • 00:17:27
    transaction to conduct it electronically
  • 00:17:29
    or on paper HIPAA does not require that
  • 00:17:33
    you choose one method however if you
  • 00:17:36
    choose to conduct electronic
  • 00:17:37
    transactions you must use the HIPAA
  • 00:17:40
    transactions and code sets also once a
  • 00:17:43
    provider uses an electronic transaction
  • 00:17:45
    you become a covered entity and subject
  • 00:17:48
    to the privacy rules also keep in mind
  • 00:17:50
    that after October 16th 2003 Medicare
  • 00:17:55
    will only accept paper claims under
  • 00:17:57
    limited circumstances
  • 00:18:03
    PIPA mandates the use of national
  • 00:18:06
    standards for the electronic transfer of
  • 00:18:08
    certain health care data between
  • 00:18:10
    healthcare providers health plans health
  • 00:18:12
    care clearing houses it replaces many
  • 00:18:15
    non-standard formats with a single set
  • 00:18:17
    of electronic standards to be used
  • 00:18:19
    throughout the US healthcare industry
  • 00:18:22
    standards have been developed for eight
  • 00:18:24
    of the ten transactions we'll review
  • 00:18:26
    these in a moment not every covered
  • 00:18:29
    entity will conduct all of these
  • 00:18:31
    transactions for instance health care
  • 00:18:34
    providers would not engage in enrollment
  • 00:18:36
    or disenrollment
  • 00:18:37
    in a health plan for each of the
  • 00:18:39
    transaction standards
  • 00:18:41
    there is also an Associated
  • 00:18:43
    implementation guide implementation
  • 00:18:45
    guides can be thought of as big recipe
  • 00:18:48
    books which provide detailed technical
  • 00:18:50
    specifications that explain how to build
  • 00:18:53
    a standard transaction this includes
  • 00:18:56
    format specifications content
  • 00:18:59
    specifications and certain code sets
  • 00:19:02
    these guides define the data elements
  • 00:19:04
    that are required for electronic
  • 00:19:06
    transactions implementation guides
  • 00:19:09
    provide important information for an
  • 00:19:11
    information technology group or vendor
  • 00:19:14
    that handles electronic claims
  • 00:19:15
    submission while many covered entities
  • 00:19:18
    may never need to look at an
  • 00:19:20
    implementation guide it is important to
  • 00:19:22
    know that they exist software vendors
  • 00:19:26
    may rely on these to update your billing
  • 00:19:28
    software these guides may be downloaded
  • 00:19:31
    for free from the website on your screen
  • 00:19:35
    providers should also contact their
  • 00:19:37
    payers and inquire whether they have
  • 00:19:40
    companion guides available to accompany
  • 00:19:42
    the implementation guides if available
  • 00:19:45
    companion guides can provide additional
  • 00:19:47
    information that is helpful in
  • 00:19:49
    interpreting the implementation guides
  • 00:19:52
    now let's return to the specific
  • 00:19:54
    standards that have been adopted for
  • 00:19:56
    each of the eight transactions
  • 00:19:57
    please note that health care providers
  • 00:19:59
    should mainly concern themselves with
  • 00:20:01
    the first five transactions as the other
  • 00:20:04
    ones may not apply to them the
  • 00:20:07
    regulation adopted what is commonly
  • 00:20:09
    referred to as the ASC x12 and 837
  • 00:20:12
    format for healthcare claims and
  • 00:20:15
    coordination of benefits
  • 00:20:17
    professional institutional and dental
  • 00:20:19
    claims this format and many of the other
  • 00:20:22
    adopted standards have been developed
  • 00:20:23
    and maintained by x12 standards
  • 00:20:25
    development organization who has been
  • 00:20:27
    accredited by the american national
  • 00:20:29
    standards institute as the standards
  • 00:20:31
    organization for many electronic
  • 00:20:33
    transactions for retail pharmacy drug
  • 00:20:36
    claims the regulation adopted the NCPDP
  • 00:20:39
    telecommunication version 5.1 and batch
  • 00:20:42
    standard 1.1 for healthcare payment and
  • 00:20:45
    remittance advice the regulation adopted
  • 00:20:48
    ASC x12 and 835 currently many providers
  • 00:20:53
    spend precious time reconciling
  • 00:20:55
    submitted claims with the paper
  • 00:20:57
    remittance advice under HIPAA providers
  • 00:21:01
    can get electronic remittance advices
  • 00:21:03
    from health plans and their practice
  • 00:21:05
    management systems can auto post them in
  • 00:21:08
    essence you'll be able to conduct claims
  • 00:21:11
    accounting without wasting staff time
  • 00:21:14
    for health claim status the regulation
  • 00:21:17
    adopted ASC x12 in 276 and 277 office
  • 00:21:23
    staff who have been spending time on
  • 00:21:24
    hold calling a health plan to check on
  • 00:21:26
    the status of a claim will now be able
  • 00:21:28
    to electronically request claim status
  • 00:21:30
    information and get the answer without
  • 00:21:32
    using the phone for eligibility for
  • 00:21:35
    health plan Hiep adopted ASC x12 in 270
  • 00:21:40
    and 271 for health care eligibility
  • 00:21:43
    benefit inquiry response under HIPAA
  • 00:21:47
    providers should have fewer worries
  • 00:21:48
    about getting correct eligibility
  • 00:21:50
    information quickly for referral
  • 00:21:52
    certification and authorization the
  • 00:21:54
    transaction standard adopted is ASC x12
  • 00:21:57
    in 278 for healthcare services review or
  • 00:22:01
    request for review and response this
  • 00:22:04
    transaction is to allow providers to
  • 00:22:06
    electronically ask for permission from
  • 00:22:07
    the health plan to refer their patients
  • 00:22:09
    to other providers or to perform
  • 00:22:11
    additional procedures for enrollment and
  • 00:22:15
    disenrollment in a health plan HIPAA
  • 00:22:17
    adopted ASC x12 and 834 for benefit
  • 00:22:23
    enrollment and maintenance for health
  • 00:22:25
    plan premium payments the transaction
  • 00:22:27
    standard is ASC x12 and 824 payment
  • 00:22:32
    order remittance advice now that you
  • 00:22:36
    know what the HIPAA standards are you
  • 00:22:38
    might be wondering where they came from
  • 00:22:40
    HIPAA requires the Secretary of the
  • 00:22:42
    Department of Health and Human Services
  • 00:22:43
    to adopt standards that were developed
  • 00:22:45
    by private sector standard development
  • 00:22:47
    organizations the ASC x12 organization
  • 00:22:51
    maintains the standards and the National
  • 00:22:54
    Council for prescription drug programs
  • 00:22:56
    or NCPDP maintains the telecommunication
  • 00:22:59
    and batch standards and they can be
  • 00:23:01
    found at WWE NCPDP org in addition to
  • 00:23:08
    standard transactions the HIPAA
  • 00:23:10
    regulation also requires the use of
  • 00:23:12
    standard code sets here are the code
  • 00:23:14
    sets adopted in the final rule for
  • 00:23:17
    diagnosis and procedure codes HIPAA
  • 00:23:19
    adopted icd-9-cm that stands for
  • 00:23:24
    international classification of diseases
  • 00:23:26
    ninth revision clinical modification
  • 00:23:30
    versions 1 & 2 are maintained by the
  • 00:23:32
    Centers for Disease Control in DHHS
  • 00:23:35
    while version 3 is maintained by CMS for
  • 00:23:40
    services provided by physicians and
  • 00:23:42
    other professionals CPT 4 was adopted
  • 00:23:46
    CPT stands for current procedure
  • 00:23:48
    terminology and is maintained and
  • 00:23:51
    copyrighted by the American Medical
  • 00:23:52
    Association hit picks stands for
  • 00:23:56
    healthcare common procedure coding
  • 00:23:57
    system and is maintained by CMS these
  • 00:24:01
    codes are for products supplies and
  • 00:24:03
    services not included in the CPT four
  • 00:24:05
    codes the code stands for code on dental
  • 00:24:09
    procedures and nomenclature and is
  • 00:24:12
    maintained and copyrighted by the
  • 00:24:14
    American Dental Association finally NDC
  • 00:24:19
    stands for national drug code which is
  • 00:24:22
    used by retail pharmacies and is
  • 00:24:24
    maintained by the Food and Drug
  • 00:24:26
    Administration in DHHS the transactions
  • 00:24:30
    and code set regulation adopted these
  • 00:24:31
    first sets of HIPAA standards it also
  • 00:24:34
    created a process to allow anyone to
  • 00:24:36
    request a change in the standards six
  • 00:24:39
    organizations known as designated
  • 00:24:41
    standards maintenance organizations or
  • 00:24:43
    des
  • 00:24:43
    those were designated by the Secretary
  • 00:24:46
    of DHHS and have agreed to work together
  • 00:24:48
    to collect requests for changes to HIPAA
  • 00:24:50
    standards evaluate the requests and
  • 00:24:53
    suggestions to the standards for the
  • 00:24:55
    Secretary's consideration the six desmos
  • 00:24:58
    are the accredited standards committee
  • 00:25:00
    x12 health level 7 Inc the National
  • 00:25:04
    Council for prescription drug programs
  • 00:25:06
    the National uniformed billing committee
  • 00:25:09
    the National uniform claim committee and
  • 00:25:12
    the American Dental Association the
  • 00:25:15
    secretary may modify a standard or it's
  • 00:25:18
    implementation guides but no more
  • 00:25:19
    frequently than once every 12 months you
  • 00:25:22
    can find out more by going to the Dismal
  • 00:25:24
    website at WWF oedema org as always any
  • 00:25:31
    time you want to find out more
  • 00:25:33
    information about this or any other
  • 00:25:35
    HIPAA topic you can visit the CMS hippo
  • 00:25:38
    website in the next section we'll review
  • 00:25:42
    some steps you can take to help reach
  • 00:25:44
    HIPAA compliance
  • 00:25:46
    [Music]
  • 00:25:51
    this time for another question let's
  • 00:25:54
    listen I'm overwhelmed by HIPPA where do
  • 00:25:57
    I start watching this program is a great
  • 00:26:01
    start
  • 00:26:01
    visit the CMS website it contains many
  • 00:26:05
    helpful items the HIPAA provider
  • 00:26:07
    readiness checklist can help you get the
  • 00:26:10
    ball rolling also review the frequently
  • 00:26:13
    asked questions on the website we also
  • 00:26:15
    put HIPAA updates on our website so try
  • 00:26:18
    to get in the habit of checking it
  • 00:26:20
    monthly many of you might be wondering
  • 00:26:22
    just where to start with HIPAA in this
  • 00:26:25
    section will outline some key steps and
  • 00:26:27
    questions that covered entities should
  • 00:26:29
    be addressing to help reach compliance
  • 00:26:31
    with the electronic transactions and
  • 00:26:33
    code set standards while not
  • 00:26:36
    all-encompassing knowing where you stand
  • 00:26:38
    in relation to these steps and questions
  • 00:26:40
    should help you to better focus your
  • 00:26:42
    efforts in reaching compliance the first
  • 00:26:45
    step is HIPAA project planning assign
  • 00:26:48
    someone in your office as a HIPAA point
  • 00:26:50
    person if you haven't already done so
  • 00:26:52
    this person should be responsible for
  • 00:26:54
    all aspects of HIPAA and should have
  • 00:26:56
    access to the HIPAA decision-makers such
  • 00:26:59
    as the CEO the CFO and the CIO covered
  • 00:27:03
    entities have many ways to communicate
  • 00:27:05
    transactions and requests for
  • 00:27:07
    information you need to identify which
  • 00:27:10
    modes you use that are covered under
  • 00:27:12
    HIPAA such as diskettes direct data
  • 00:27:15
    entry or dde web-based or any other form
  • 00:27:19
    of EDI or electronic data interchange
  • 00:27:22
    paper telephone and faxing with a
  • 00:27:25
    dedicated fax machine as opposed to
  • 00:27:27
    faxing from a computer are not
  • 00:27:29
    considered electronic transactions under
  • 00:27:31
    HIPAA
  • 00:27:32
    have you identified all modes of
  • 00:27:34
    communication for all HIPAA covered
  • 00:27:36
    transactions have you identified who
  • 00:27:38
    your trading partners are what methods
  • 00:27:41
    do you use conduct HIPAA covered
  • 00:27:43
    transactions electronically your HIPAA
  • 00:27:46
    budget resources and contracts should be
  • 00:27:48
    reviewed the next step is evaluating the
  • 00:27:52
    impact on business processes and systems
  • 00:27:55
    some general points to consider include
  • 00:27:57
    have you assessed the business processes
  • 00:28:00
    for HIPAA impact of the process has been
  • 00:28:03
    prioritized for
  • 00:28:04
    contingency planning adopting the HIPAA
  • 00:28:07
    standard sets means the loss of local
  • 00:28:10
    codes as the impact of the loss of local
  • 00:28:13
    codes and adoption of standard codes on
  • 00:28:16
    your systems been assessed do you have a
  • 00:28:19
    plan for changing policies processes and
  • 00:28:21
    procedures as well as staff training to
  • 00:28:24
    accommodate the switch to standard codes
  • 00:28:26
    a system assessment in the form of a gap
  • 00:28:29
    analysis needs to be completed simply
  • 00:28:32
    put this means identifying where you
  • 00:28:34
    aren't ready or gaps between what you do
  • 00:28:37
    now and what you'll need to do under
  • 00:28:39
    HIPAA for providers the practice
  • 00:28:42
    management software vendor may be
  • 00:28:43
    responsible for all or part of gap
  • 00:28:45
    analysis points to consider as part of a
  • 00:28:48
    gap analysis include as a gap analysis
  • 00:28:52
    been performed on your systems or your
  • 00:28:53
    vendors systems have mandated standard
  • 00:28:57
    transactions been mapped as a system
  • 00:29:00
    assessment been completed in addition to
  • 00:29:03
    performing gap analyses health plans and
  • 00:29:05
    clearing houses need to need to review
  • 00:29:07
    and likely revise many of their internal
  • 00:29:10
    systems ensure that HIPPA codes fields
  • 00:29:12
    and field sizes are fully supported the
  • 00:29:15
    next step is validation and testing all
  • 00:29:18
    covered entities must perform testing
  • 00:29:21
    for providers focusing on key
  • 00:29:24
    transactions such as the claim
  • 00:29:26
    remittance advice and eligibility
  • 00:29:28
    transactions is important also if you
  • 00:29:32
    are testing with one payer you should
  • 00:29:34
    not assume that you are okay you need to
  • 00:29:37
    test with all of your payers remember
  • 00:29:40
    technical glitches can occur so be sure
  • 00:29:42
    to build in enough time the workgroup
  • 00:29:45
    and electronic data interchange and the
  • 00:29:47
    strategic national implementation
  • 00:29:48
    process or wedi snip has a suggested
  • 00:29:52
    seven step testing process that you can
  • 00:29:55
    follow as HIPAA does not specify how
  • 00:29:56
    testing should be conducted you can
  • 00:29:59
    visit wheaties website at the address on
  • 00:30:01
    your screen for more information and
  • 00:30:04
    remember testing must begin no later
  • 00:30:06
    than April 16th 2003 try to test early
  • 00:30:10
    and often as testing may take many
  • 00:30:12
    months the next step is coordinating
  • 00:30:15
    with their trading partners trading
  • 00:30:17
    partners include hell
  • 00:30:18
    plans billing services and clearing
  • 00:30:21
    houses with which you may conduct HIPPA
  • 00:30:23
    transactions here are some points to
  • 00:30:25
    consider have you contacted your trading
  • 00:30:28
    partners to determine their HIPAA
  • 00:30:29
    readiness our contracts in place with
  • 00:30:32
    vendors billing services or clearing
  • 00:30:34
    houses for HIPAA compliant transaction
  • 00:30:36
    services when will your vendor be
  • 00:30:39
    updating and sending you HIPAA compliant
  • 00:30:41
    software do you or your system vendor
  • 00:30:44
    have a schedule for design development
  • 00:30:46
    and implementation do you have a way to
  • 00:30:49
    track system modification status and
  • 00:30:52
    progress have you or your system vendor
  • 00:30:55
    decided on an overall approach to
  • 00:30:57
    achieving compliance is everyone aware
  • 00:31:01
    of the April 16th 2003 testing deadline
  • 00:31:04
    while trading partner agreements or TPAs
  • 00:31:08
    are not required by HIPAA these
  • 00:31:10
    agreements specify the communication
  • 00:31:13
    methods and specific processing and code
  • 00:31:15
    requirements not determined by the HIPAA
  • 00:31:18
    transaction implementation guides while
  • 00:31:21
    the HIPAA standards address data format
  • 00:31:23
    and content they do not address other
  • 00:31:25
    issues such as the method by which
  • 00:31:27
    trading partners can accept and send
  • 00:31:30
    transactions and many data elements are
  • 00:31:33
    considered situational which means they
  • 00:31:36
    are required as a given situation is met
  • 00:31:39
    however these sorts of issues are not
  • 00:31:42
    addressed in the standards and should be
  • 00:31:44
    outlined in a TPA some additional
  • 00:31:47
    questions to be asking include have
  • 00:31:50
    transmission methods been agreed upon
  • 00:31:52
    have situational data elements been
  • 00:31:55
    identified do you have the appropriate
  • 00:31:58
    implementation guides and companion
  • 00:31:59
    guides have you accepted the processing
  • 00:32:03
    and code requirements not determined by
  • 00:32:04
    HIPAA
  • 00:32:05
    [Music]
  • 00:32:11
    CMS has been designated by the Secretary
  • 00:32:14
    of DHHS to enforce all the hip
  • 00:32:16
    administrative simplification provisions
  • 00:32:18
    with the exception of the privacy
  • 00:32:20
    standards this includes transactions and
  • 00:32:23
    code set standards and security and
  • 00:32:25
    identifier standards after they are in
  • 00:32:27
    effect the office for civil rights or
  • 00:32:30
    OCR at DHHS is responsible for
  • 00:32:33
    enforcement of the privacy provisions
  • 00:32:35
    the enforcement process for both will be
  • 00:32:38
    primarily complaint driven thus the
  • 00:32:41
    process leading to any penalties will be
  • 00:32:43
    initiated primarily in response to an
  • 00:32:46
    external complaint filed against the
  • 00:32:48
    covered entity CMS will provide
  • 00:32:51
    opportunities for a covered entity to
  • 00:32:53
    demonstrate compliance or submit a
  • 00:32:55
    corrective action plan with the focus on
  • 00:32:57
    obtaining voluntary compliance through
  • 00:32:59
    technical assistance CMS will notify you
  • 00:33:03
    by letter only if a complaint is filed
  • 00:33:05
    against you at that time you will have
  • 00:33:08
    the opportunity to show compliance or to
  • 00:33:10
    submit a corrective action plan only if
  • 00:33:13
    you do none of these things with
  • 00:33:14
    consideration be given to invoking
  • 00:33:15
    penalties and what are the penalties
  • 00:33:18
    civil monetary penalties of not more
  • 00:33:21
    than $100 per violation capped at
  • 00:33:24
    $25,000 for each requirement or
  • 00:33:26
    prohibition that is violated criminal
  • 00:33:30
    penalties of up to fifty thousand
  • 00:33:32
    dollars in one year imprisonment for
  • 00:33:34
    knowingly obtaining or disclosing
  • 00:33:36
    individually identifiable health
  • 00:33:38
    information and violation of the HIPAA
  • 00:33:40
    rules up to $100,000 in five years
  • 00:33:43
    imprisonment if the violation is
  • 00:33:45
    committed under false pretenses and up
  • 00:33:48
    to two hundred and fifty thousand
  • 00:33:50
    dollars and ten years imprisonment if
  • 00:33:52
    the violation is committed with intent
  • 00:33:53
    to sell transfer or used for commercial
  • 00:33:56
    advantage personal gain or malicious
  • 00:33:59
    harm all criminal penalties are under
  • 00:34:02
    the jurisdiction of the Department of
  • 00:34:03
    Justice
  • 00:34:04
    [Music]
  • 00:34:09
    the enforcement aspect of administrative
  • 00:34:12
    simplification is still in the early
  • 00:34:13
    stages again
  • 00:34:16
    CMS's emphasis is on ensuring everyone
  • 00:34:19
    becomes compliant with the HIPAA
  • 00:34:20
    provisions while it's true that
  • 00:34:22
    penalties can be imposed the first
  • 00:34:25
    course of action will focus on providing
  • 00:34:26
    technical assistance aimed at helping an
  • 00:34:29
    entity reach compliance for the most
  • 00:34:32
    recent information with regard to
  • 00:34:34
    enforcement and other general areas of
  • 00:34:36
    HIPAA administrative simplification
  • 00:34:38
    visit the CMS website at WWF SG / /
  • 00:34:48
    HIPAA - to learn more about HIPAA and
  • 00:34:51
    privacy or privacy enforcement issues
  • 00:34:54
    visit OCR's website at WWE
  • 00:35:04
    now that we have provided you with an
  • 00:35:07
    introduction to HIPAA you may still be
  • 00:35:09
    wondering how the administrative
  • 00:35:10
    simplification provisions of HIPAA will
  • 00:35:12
    benefit you let's meet dr. Barbara Paul
  • 00:35:15
    CMS official practicing physician and
  • 00:35:18
    covered entity dr. Paul is the director
  • 00:35:21
    of quality measurement and health
  • 00:35:23
    assessment group at CMS thanks John
  • 00:35:27
    hello I'm Barbara Paul one of the many
  • 00:35:29
    practicing physicians who work at CMS as
  • 00:35:32
    I listen to this program I realized that
  • 00:35:35
    I had many of the same questions you
  • 00:35:36
    heard today as I navigate my way through
  • 00:35:39
    HIPAA I try to be patient with the
  • 00:35:42
    stresses and strains of transitioning
  • 00:35:44
    from the 400 different formats for
  • 00:35:46
    submitting claims currently in use today
  • 00:35:49
    what keeps me going and I hope will keep
  • 00:35:52
    you going as well is the prospect of
  • 00:35:54
    simpler more streamlined administrative
  • 00:35:57
    environment for physicians and the
  • 00:35:58
    healthcare industry overall John and
  • 00:36:02
    Valerie have already mentioned many of
  • 00:36:03
    the advantages of a HIPAA compliant
  • 00:36:05
    practice speedy determination of your
  • 00:36:08
    patient's eligibility giving you fewer
  • 00:36:11
    worries about what's covered in who to
  • 00:36:12
    bill the promise of prior authorization
  • 00:36:16
    and referral requests for your patients
  • 00:36:17
    in any health plan and much quicker
  • 00:36:20
    turnaround for these requests without
  • 00:36:22
    ever picking up the phone you'll also be
  • 00:36:25
    able to send in bills and batches or
  • 00:36:27
    online and get a speedy response from
  • 00:36:29
    your payer if they cannot be processed
  • 00:36:32
    thus physicians will be paid faster and
  • 00:36:35
    have fewer administrative hassles that
  • 00:36:38
    should translate into more time for
  • 00:36:40
    patient care another benefit is that
  • 00:36:43
    administrative simplification mandates
  • 00:36:46
    that health care entities implement a
  • 00:36:48
    set of standards that will be used by
  • 00:36:50
    all sectors of the healthcare industry
  • 00:36:51
    thus eliminating the use of local codes
  • 00:36:55
    this means that under HIPAA
  • 00:36:57
    your office will use the same set of
  • 00:37:00
    codes for the same procedure with all
  • 00:37:02
    health plans that you bill before HIPAA
  • 00:37:05
    you had to know which local code to bill
  • 00:37:07
    which health plan for the same service
  • 00:37:10
    thanks dr. Paul in general Hiep intends
  • 00:37:14
    to reduce the cost of administrative
  • 00:37:16
    operations to simplify the electronic
  • 00:37:18
    exchange of information and to prevent
  • 00:37:21
    unauthorized access to patient health
  • 00:37:23
    information your patients to see fast
  • 00:37:26
    responses to the concerns such as unpaid
  • 00:37:28
    bills or access to patient records and
  • 00:37:31
    this should serve to improve your
  • 00:37:33
    patient satisfaction with you it is time
  • 00:37:37
    for another HIPAA question my vendor
  • 00:37:40
    says they're handling everything so I
  • 00:37:42
    don't need to worry about HIPAA right
  • 00:37:44
    good question but you do need to worry
  • 00:37:47
    about HIPAA if you are a covered entity
  • 00:37:50
    you are ultimately responsible for
  • 00:37:53
    compliance not your vendor or anyone
  • 00:37:55
    else so it's important that you
  • 00:37:57
    understand the deadlines and details
  • 00:37:59
    about HIPAA and its impact on your
  • 00:38:01
    business and communicate often with your
  • 00:38:04
    payers software vendors billing service
  • 00:38:06
    or clearing houses to find out where
  • 00:38:08
    they are with HIPAA implementation in
  • 00:38:11
    our final segment we'll review important
  • 00:38:14
    facts from our program and tell you
  • 00:38:17
    about additional resources you can
  • 00:38:18
    access to find out more information
  • 00:38:20
    hipper
  • 00:38:21
    [Music]
  • 00:38:27
    by now you should have a better
  • 00:38:29
    understanding of the many aspects of
  • 00:38:31
    complying with HIPAA administrative
  • 00:38:33
    simplification provisions remember that
  • 00:38:36
    the next compliance date is April 14
  • 00:38:39
    2003 this is a deadline for meeting the
  • 00:38:42
    privacy requirements with the exception
  • 00:38:45
    of small health plans who have another
  • 00:38:47
    year then just two days later is the
  • 00:38:50
    testing deadline for all covered
  • 00:38:52
    entities who submitted a compliance
  • 00:38:54
    extension form compliance with the
  • 00:38:57
    electronic transactions and code set
  • 00:39:00
    standards for all covered entities
  • 00:39:02
    including small health plans is required
  • 00:39:05
    by October 16 2003 the compliance
  • 00:39:10
    deadline for privacy is April 14th 2004
  • 00:39:13
    for small health plans the compliance
  • 00:39:17
    date for national employer identifier is
  • 00:39:19
    July 30th 2004 for all covered entities
  • 00:39:23
    except small health plans small health
  • 00:39:27
    plans have until August 1st 2005 to
  • 00:39:30
    comply the compliance date for security
  • 00:39:33
    is April 21st 2005 for all covered
  • 00:39:37
    entities except small health plans small
  • 00:39:40
    health plans have until April 21st 2006
  • 00:39:44
    to comply to find out more information
  • 00:39:47
    about HIPAA administrative
  • 00:39:49
    simplification there are a number of
  • 00:39:51
    resources available the HIPAA hotline
  • 00:39:54
    number is available to answer your
  • 00:39:55
    questions
  • 00:39:56
    that number is 186 - 8 - 0 6 5 9 this
  • 00:40:04
    hotline can help you with your questions
  • 00:40:06
    about electronic transactions and code
  • 00:40:08
    sets unique identifier z' and security
  • 00:40:11
    please direct your privacy questions to
  • 00:40:14
    the HIPAA privacy hotline that number is
  • 00:40:17
    186 6 6 to 7 7 7 4 8 the CMS HIPAA
  • 00:40:24
    website is another good resource of
  • 00:40:26
    information it's updated frequently and
  • 00:40:29
    provides access to free tools and
  • 00:40:31
    information such as the covered entity
  • 00:40:34
    decision tool a provider readiness
  • 00:40:36
    checklist information on upcoming
  • 00:40:39
    conference calls and enforcement
  • 00:40:41
    information plus access to frequently
  • 00:40:44
    asked questions about HIPAA the address
  • 00:40:47
    is wwg ms HHS gov / HIPAA / HIPAA - for
  • 00:41:01
    more information on the HIPAA privacy
  • 00:41:03
    provisions visit WWH HS govt / OC r /
  • 00:41:11
    HIPAA this website includes privacy
  • 00:41:15
    guidance documents and sample business
  • 00:41:17
    associate contract provisions here are
  • 00:41:20
    some additional web resources that you
  • 00:41:22
    might find useful
  • 00:41:24
    [Music]
  • 00:42:04
    you
  • 00:42:06
    [Music]
  • 00:42:14
    we hope you have found the information
  • 00:42:16
    in this program helpful in your efforts
  • 00:42:18
    to comply with the administrative
  • 00:42:19
    simplification provisions of pepper
  • 00:42:21
    thank you for watching and remember to
  • 00:42:24
    check our website for the latest HIPPA
  • 00:42:26
    information
  • 00:42:30
    [Music]
  • 00:43:00
    you
  • 00:43:02
    [Music]
Tags
  • HIPAA
  • healthcare
  • compliance
  • electronic transactions
  • privacy
  • security
  • covered entities
  • administrative simplification
  • health information
  • standards