Hipaa Medical Compliance

Written by Kimberly Clark
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HIPAA stands for the Health Insurance Portability & Accountability Act of 1996. There are several sections of HIPAA, so compliance with its standards means very different things to different entities. The portion of the regulations which addresses the federal standardization of electronic healthcare transactions is referred to as HIPAA Administration Simplification Provisions or Title II, Subtitle F.

Title II, Subtitle F of HIPAA was passed to: 1) adopt standards for transactions and code sets that are used to electronically exchange healthcare data; (2) adopt standard identifiers for health plans, health care providers, employers, and individuals for use on standard transactions; and (3) adopt standards to protect the security and privacy of personally identifiable health information. The healthcare transactions required to conform to the standards include submission of claims, enrollment, and referral forms. In addition, transmission of healthcare provider invoices and health plan premium payments are also governed by HIPAA.

The businesses or organizations mandated to meet HIPAA compliance are called covered entities. Healthcare plans such as Medicare, Blue Cross/Blue Shield, HMOs and providers like physicians, dentists, and hospitals are examples of covered entities. Healthcare clearinghouses also fall into this category.

Failure to Meet HIPAA Compliance

HIPAA was enacted and implemented by the Department of Health and Human Services (HHS) and compliance with its guidelines is enforced by the Centers for Medicare & Medicaid Services (CMS). The deadline set for regulated entities to comply with the HIPPA, Title II standards was October 16, 2003. Noncompliant entities can be barred from participating in the Medicare program, as well as assessed certain fines. Those not participating in the Medicare programs could be charged stiff financial penalties.


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