More deadlines approach with HCFA’s (Health Care Finance Administration) rules.

National Provider Identifier Number (NPI) Deadline Rapidly Approaching

The HIPAA Administrative Simplification Component will become mandatory in May of this year (2007).

One component of HIPAA's Administrative Simplification provision becomes a legal mandate May 23, 2007. To comply with this mandate, all health care providers must obtain a National Provider Identifier number or NPI.

NPI Tips & Facts

Not all payers are ready to accept the NPI number at this time. Providers are advised to use both their existing (legacy) number and the NPI number when submitting electronic claims.

When the NPI number is received, test transactions with payer entities well before the deadline. You will also need to notify and test with your electronic claims clearinghouse.

HCFA (health Care Finance Administration) Changes

Changes in the HCFA 1500 form to accommodate the NPI number took place January 1, 2007. It is optional whether to use an NPI number on the HCFA form until March 30, 2007. It becomes mandatory April 2, 2007. The new HCFA form will have new fields for identifier numbers on lines 17b, 32a and 33a.

HIPAA Review

HIPAA, which stands for the American Health Insurance Portability and Accountability Act of 1996, is a set of rules to be followed by doctors, hospitals and other health care providers. HIPAA took effect in April 2006. HIPAA helps ensure that all medical records, medical billing, and patient accounts meet certain consistent standards with regard to documentation, handling and privacy.

In addition, HIPAA requires that all patients be able access their own medical records, correct errors or omissions, and be informed how personal information is shared used. Other provisions involve notification of privacy procedures to the patient. HIPAA provisions have led in many cases to extensive overhauling with regard to medical records and billing systems.

Despite the April 2006 deadline for compliance with the final HIPAA rule, only 30 percent of payers and 18 percent of healthcare providers who responded to a Healthcare Information and Management Systems Society survey indicate that they are compliant with these regulations. This website can help you become more educated about this important subject. Look at the Medical Office Manager Course for details.

What are the main objectives of HIPAA?

1. Accountability. HIPAA hopefully will reduce waste, fraud, and abuse. New penalties will be imposed.

2. Insurance Reform. HIPAA offers continuity and portability of health insurance, as well as providing limits on pre-existing provisions.

3. Administrative simplification. HIPAA mandates standards on electronic data transactions in a confidential and secure manner.

Who must comply with HIPAA?

Any healthcare provider that electronically stores, processes or transmits medical records, medical claims, remittances, or certifications must comply with HIPAA regulations. HIPAA does not require a practice to purchase a computer-based system as it applies only to electronic medical transactions.

What is the difference between HIPAA-ready and HIPAA-compliant? HIPAA-ready typically refers to software products used by healthcare providers, insurance companies and clearing houses that comply with HIPAA guidelines. HIPAA-compliant refers to the doctors, hospitals and insurance companies themselves that are in compliance with HIPAA regulations.

Does HIPAA specify how compliance is to be achieved? No. HIPAA regulations give health-care organizations the decision to decide how they will implement HIPAA compliance, and are technology and software-neutral.

What are the HIPPA compliance deadlines?

1. Privacy Rule: April 14, 2006
2. Transactions & Code Set Rule: October 16, 2006
3. Security Rule: April 21, 2006
(Note: The deadline dates are one year later for small businesses)

XYZ HEALTH PLAN PRIVACY NOTICE

At XYZ Health Plan, we respect the confidentiality of your information in a responsible and professional manner the privacy of your health information and to provide you this notice.

This notice explains how we use information about you and when we can share that information with others. It also informs you of your rights with respect to your health information and how you can exercise those rights.

When we talk about "information" or "health information” in this notice we mean the following:

HOW WE USE OR SHARE INFORMATION

The following are ways we may use or share information about you:

• We may use the information to help pay your medical bills.
  
• We may share your information with your doctors or hospitals to help them provide medical care to you.
  
• We may use information with others to help manage your health care. For example, we might talk to your doctor to suggest a disease management or wellness program that could help improve your health.
  
• We may share your information with others who help us conduct our business operations. We will not share your information with such outside groups unless they agree to keep it protected.
  
• We may use or share your information for certain types of public health or disaster relief efforts.
  
• We may use or share your information to send you appointment reminders.
  

PATIENT RIGHTS (SAMPLE)

The following are patient rights with respect to health information.

• You have the right to ask that your records be restricted and to whom they may be disclosed.
  
• You have the right to ask to receive confidential communications of information.
  
• You have the right to inspect and obtain a copy of information that is maintained about you (designated record).
  
• You have the right to ask that changes be made in information that is maintained in your designated record set. (Some require this in writing.)
  
• You have the right to receive an accounting of certain disclosures of your information during the six years preceding a request.
  
• The rules grow ever more cumbersome and compliance more critical. Medical practices must be prepared. Meditec will help your staff learn all about the rules.