A current LCD for the regional Medicare intermediary (Michigan - Region V) is shown in the example below. This LCD is for Erythropoiesis Stimulating Agents, L25211. The LCD is active and became effective on 12/1/2007 with an date of 11/01/2013 for the 10/22/2013 revision (cms.gov, 2014b).
Question 8: Report on the Health Insurance Portability And Accountability Act (HIPAA) and its impact on healthcare claims processing.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was created, in part, to make health insurance portable in an attempt to address the problem of the growing amount of people that are uninsured and underinsured (NASW,2002). The Act allows a person with preexisting medical issues to get health insurance when changing jobs. HIPAA also addressed healthcare fraud and abuse. A significant impact to healthcare providers by HIPAA were the Administrative Simplification Provisions that were specified to improve healthcare quality and reduce costs by simplifying how health information is administered and managed. The provisions were also developed to protect the privacy and security of protected health information (PHI). Under the HIPAA provisions regulations have been issued to define standard electronic formats for transactions such as claims submission and billing that identify uniform data codes for diagnoses and procedures and security standards to maintain confidentiality and privacy of health information. Important parts of HIPAA include the Privacy Rule, Security Rule, and Electronic Transactions Rule (Casto & Forrestal, 2013).
• Privacy Rule o The HIPAA Privacy Regulations were published on December 28, 2000 to become compliant on April 14, 2003 (NASW, 2002). The in...
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...rsuant to section 1560(c) of the Affordable Care Act, specify certain Public Health Service Act and Affordable Care Act requirements as inapplicable to this type of individual health insurance” (Federal Register, 2014b).
An example of a final rule published in the Federal Register is the “FY 2013 Final Rule Tables” that contains links to tables that provide information regarding reimbursement adjustments (CMS.gov, 2014). Examples of items listed on the tables include:
• FY 2013 Operating and Capital National and Puerto Rico Specific Standardized Amounts
• Wage Index Final Rule and Correction Notice Tables
• List of Final MS-DRGs, Relative Weighting Factors and Geometric And Arithmetic Mean LOS
• New Procedure Codes, CC Exclusions List, Complete MCC List, Additions and Deletions
• Readmission Adjustment Factors Under the Hospital Readmissions Reduction Program
As the evolution of healthcare from paper documentation to electronic documentation and ordering, the security of patient information is becoming more difficult to maintain. Electronic healthcare records (EHR), telenursing, Computer Physician Order Entry (CPOE) are a major part of the future of medicine. Social media also plays a role in the security of patient formation. Compromising data in the information age is as easy as pressing a send button. New technology presents new challenges to maintaining patient privacy. The topic for this annotated bibliography is the Health Insurance Portability and Accountability Act (HIPAA). Nursing informatics role is imperative to assist in the creation and maintenance of the ease of the programs and maintain regulations compliant to HIPAA. As a nurse, most documentation and order entry is done electronically and is important to understand the core concepts of HIPAA regarding electronic healthcare records. Using keywords HIPAA and informatics, the author chose these resources from scholarly journals, peer reviewed articles, and print based articles and text books. These sources provide how and when to share patient information, guidelines and regulation d of HIPAA, and the implementation in relation to electronic future of nursing.
The major goal of HIPAA or Health Insurance Portability and Accountability Act is to provide insurance portability, fraud enforcement, and administrative simplification for the health care industry. HIPAA was created because of the growing concerns about keeping health care information private, the need to consolidate non-standard health care data ...
HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information ad help the healthcare industry control administrative costs. HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. HIPAA was first introduced in 1996. It was made a law by the United States Congress and signed by President Bill Clinton. The HIPAA Privacy Rule protects an individual’s medical records and other personal health information.
This paper will examine the privacy rules of the Health Insurance Portability and Accountability Act (HIPAA) of 1996
Health Insurance Portability and Accountability Act or HIPAA is a statute endorsed by the U.S. Congress in 1996. It offers protections for many American workers which improves portability and continuity of health insurance coverage. The seven titles of the final law are Title I - Health care Access , Portability, Title II - Preventing Health Care Fraud and Abuse; administrative simplification; Medical Liability Reform; Title III – Tax-related Health Provisions; Title IV – Application and Enforcement of Group Health Plan Requirements; Title V – Revenue Offsets; Title XI – General Provisions, Peer Review, Administrative Simplification; Title XXVII – Assuring Portability, Availability and Renewability of Health Insurance Coverage. (Krager & Krager, 2008)
Previously, healthcare information has been protected by state law. However, since this information crosses state lines, the need for federal protection has been warranted. In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). HIPAA provides the first federal protection for the privacy of medical records (Burke & Weill, 2005) HIPPA encourages the use of electronic medical record and the sharing of medical records between healthcare providers, because it can aid in saving lives. HIPAA requires that patients have some knowledge of the use of their medical records and must be notified in writing of their providers' privacy policy. HIPAA has technical requirements which a healthcare provider, insurer, or service provider, unless exempt under state law, must provide. An organization must conduct a self evaluation to learn what threats its records face, and develop techniques needed to protect the information (HIPAA, 1996). HIPAA's purpose is to protect the privacy of the consumers.
ACA Policies and Resolutions. (2004, October). Corrections Today, 66(6). Retrieved April 12, 2005, from EBSCOhost Web site: http://web9.epnet.com/citation.asp?tb
The Health Insurance Portability and Accountability Act, most commonly known by its initials HIPAA, was enacted by Congress then signed by President Bill Clinton on August 21, 1996. This act was put into place in order to regulate the privacy of patient health information, and as an effort to lower the cost of health care, shape the many pieces of our complicated healthcare system. This act also protects individuals from losing their health insurance if they lose their employment or choose to switch employers. . Before HIPAA there was no standard or consistency for the enforcement of the privacy for patients and the rules and regulations varied by state and organizations. HIPAA virtually affects everybody within the healthcare field including but not limited to patients, providers, payers and intermediaries. Although there are many parts of the HIPAA act, for the purposes of this paper we are going to focus on the two main sections and the four objectives of HIPAA, a which are to improve the portability (the capability of transferring from one employee to another) of health insurance, combat fraud, abuse, and waste in health insurance, to promote the expanded use of medical savings accounts, and to simplify the administration of health insurance.
To be considered meaningful users of the EMR, the qualified applicant must use clinical content that is consistent and standardized across systems and healthcare settings, use decision support tools such as alerts and reminders, have the ability to collect and store raw data from documentation that can be used for reporting purposes, collect and report data to the state. Reporting of data will help to improve public health and awareness and provide sharing of information between systems (Tripathi,
Congress addressed growing public concern about privacy and security of personal health data, and in 1996 passed “The Health Insurance Portability and Accountability Act” (HIPAA). HIPAA sets the national standard for electronic transfers of health data. Before HIPAA, each state set their own standards. Now states must abide by the minimum standards set by HIPAA. States can enact laws to incorporate and/or strengthen the basic rights given by HIPAA.
The Health and Human Services (HHS) settled a case with Blue Cross Blue Shield of Tennessee (BCBST) for $1.5 million for violating the Health Insurance Portability and Accountability Act (HIPAA) and security rules. There are security issues with BCBST in regard to confidentiality, integrity, availability, and privacy. There are also security requirement by HIPAA which could have prevent the security issue if it has been enforced. There are correction actions taken by BCBST which were efficient and some may have not been adequate. There are HIPAA security requirements and safeguards organization need to implement to mitigate the security risk in terms of administrative, technical, and physical safeguards.
What is HIPAA? The Health Insurance Portability & Accountability Act of 1996 (HIPAA) was passed by the U.S. Congress to improve portability and continuity of health insurance coverage; to combat waste, fraud and abuse in health insurance; to reduce costs and the administrative burdens by improving efficiency and effectiveness of the health care system by standardizing the interchange of electronic data; and to ensure the pri...
The Health Insurance Portability and Accountability Act passed and were signed into law on August 21, 1996. It affects the medical facility and its day to day operations; in many different ways. HIPAA sets higher standard of operation for healthcare workers and the facilities. "HIPAA was instituted to "improve the portability and continuity of health insurance coverage; to combat waste, fraud, and abuse in health insurance and healthcare delivery; to promote the use of medical savings accounts, to improve access to long term care services and coverage; to simplify the administration of health insurance; and to serve other purposes" (Kinn’s, 2011).
While the HIPAA regulations call for the medical industry to reexamine how it protects patient information, the standards put in place by HIPAA do not provide ...
The Health Insurance Portability and Accountability Act of 1996, or HIPAA, is a law designed “to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.”1 HIPAA mandates that covered entities must employ technological means to ensure the privacy of sensitive information. This white paper intends to study the requirements put forth by HIPAA by examining what is technically necessary for them to be implemented, the technological feasibility of this, and what commercial, off-the-shelf systems are currently available to implement these requirements.