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Are you HIPAA compliant?  Take the Short Quiz at the bottom of this page...or click on the hyperlink to take...The Complete HIPAA Compliancy Test        

HIPAA - The Final Rule     This information reprinted from the Medicare Part B New Issue 186

Privacy Protection of Health Information

What's new with HIPAA?  In 1996, Congress passed into law the Health Insurance Portability and Accountability Act (HIPAA). This Act is comprised of two major legislative actions: Health Insurance Reform and Administrative Simplification. The Administrative Simplification provision of HIPAA direct the federal government to adopt national electronic standards for automated transfer of certain health care data between health care payers, plans and providers. This will enable the entire health care industry to communicate electronic data using a single set of standards thus eliminating all nonstandard formats currently in use. Once these standards are in place, a healthcare provider will be able to submit a standard transaction for eligibility, authorization, referrals, claims, or attachments containing the same standard data to any health plan. This will "simplify" many clinical, billing, and other financial applications and reduce costs.

The Transaction Final Rule is the first to be published in the Federal Register. It was published on August 17, 2000, and requires providers to use the applicable standards for electronic transactions such as:

Submitting claims
Receiving remittance advice statements
Querying patient eligibility
Checking claims status
Requesting prior authorization where required for certain items of durable medical equipment
Requesting payment for the limited number of drugs covered by Medicare

These standards will be fully implemented April 14, 2003. When fully implemented, Medicare contractors and other health care payers will be prohibited from accepting or issuing transactions that do not meet the new standards.

Health care providers and suppliers who conduct business electronically are urged to begin considering what steps they may need to take to upgrade their software to conform to the new standards. This can be done either independently or through commercial vendors. Health Providers can also consider arranging for the services of a commercial clearing hourse or billing service knowledgeable about the new requirements to translate data on their behalf.

A copy of the Transaction and Code Set Final Rule, as well as more information on the full range of Administrative Simplification requirements, can be obtained from the following link.

A short quiz for testing HIPAA compliance in your clinic.

Answer the questions below

Yes

No

Can the patients name be identified on every record?

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Is there a signed release of medical information form on file?

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.

Are the CPT / ICD9 codes in direct correlation with the medical records?

.

.

Can a physician signature be identified on the medical history, exam form as well as the progress note?

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.

Is your practice continually educating staff on coding issues and changes?

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.
Are your computer monitors visible to your patients?

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.

Are waiver of liability forms being utilized for all potential disallowed procedures?

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.

Do you consistently collect all co-pays regardless of the amount?

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.

Do you have carrier coverage guidelines as well as a procedure to reference?

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If you are using a superbill, are the codes reflected current and appropriate?

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Is the superbill updated on a frequent basis? (Biannually)

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Are periodic internal coding audits conducted and results as well as corrective action plan documented and instituted?

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Do you keep the EOBs on file for 7 years?

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Is the information contained on the EOB distributed to the appropriate staff?

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.

These are just some of the recommendations to ensure compliance within your practices coding policies. For all questions above that received a “NO” response, it would be wise to have Smg begin to develop an action plan to show intent to correctly and efficiently comply with coding guidelines.  This is just one area where Smg can assist you with our HIPAA Consulting Services.

We suggest that you immediately have an Smg representative conduct an in-depth HIPAA review of your practice and policies relating to HIPAA Guidelines.

Even if you do not use Raintree Software Smg can assist you in all matters relating to complete HIPAA compliancy. 

Speak with your Smg Representative today by calling 253.874.8351  

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Last modified: November 18, 2002