HIPAA became law 1996
What is the purpose of HIPAA? • To make health insurance portable under ERISA;
• To move health care onto a nationally standardized electronic billing platform; and
• To prevent fraud, waste and abuse
Intent purpose of this subtitle to improve the Medicare progra...
HCCA - CHPC Overview Latest 2023
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HIPAA became law ✔✔1996
What is the purpose of HIPAA? ✔✔• To make health insurance portable under ERISA;
• To move health care onto a nationally standardized electronic billing platform; and
• To prevent fraud, waste and abuse
Intent ✔✔purpose of this subtitle to improve the Medicare program under title XVIII of the
Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and
effectiveness of the health care system, by encouraging the development of a health information
system through the establishment of standards and requirements for the electronic transmission
of certain health information.
HIPAA resides in what CFR section ✔✔45 CFR sections 164.102 through 164.534
Identify the four sections in the CFR by location and topic ✔✔Section One: 164.102 - 164.318
and 164.530 - 164-534 Organizational Requirements
,Section Two: 164.500 - 164.514 Use and Disclosure of Information
Section Three: 164.520 - 164.528 Individual's Rights and Penalties
Section Four: Interaction with the HIPAA Security Rule
How do you determine if organization is a CE ✔✔- compare the functions of the entity to the
three principal types of "covered entities" (CE),
- determine if the entity electronically transmits one of the nine defined transactions"
What are the different types of CEs ✔✔- Provider
- Health Plan
- Clearing House
- Other Types
How is a Provider defined ✔✔- "a provider of services (as defined in section 1395x (u) of title
XIX)
- a provider of medical or other health services (as defined in section 1395x (s) of title XIX)
, - any other person furnishing health care services or supplies.
Does a provider need a standing facility to be considered a CE ✔✔NO
What does "Health Plan" mean? ✔✔An individual or group plan that provides, or pays the cost
of, medical care
• A group health plan, but only if the plan:
-- has 50 or more participants
-- is administered by an entity other than the employer who established and maintains the plan.
• A health insurance issuer
• A health maintenance organization
• The Medicaid program under title XIX.
• A Medicare supplemental policy
• A long-term care policy, including a nursing
home fixed indemnity policy
• An employee welfare benefit plan providing health benefits to the employees of 2 or more
employers.
• The health care program for active military
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