All the professionals and workers working in the health care industry in America are required to comply with HIPAA standards. This federal law ensures that patients who have a pre-existing condition get the right insurance coverage and are not excluded on these grounds by their health care provider.
This law also prevents malpractice by insurance companies and doctors and also provides a savings account for medical purposes. This law was in response to the demand of health industry to shift to electronic transaction standards to help hospitals and other concerns cut cost and increase the security of the medical records of patients.
Thus HHS or Department of Health and Human Services created HIPAA standards to control and regulate administrative and financial transaction in medical field. They have created codes for health plans, hospitals, retail pharmacies, nursing homes etc. to ensure security and privacy of identifiable information in medical records of individual.
These codes were standardized so that the multiple versions of electronic HCFA 1500 and UB-92 can be replaced. These standards were adopted back in April 2007 and are applicable to all kinds of health plans, clearing houses, hospitals etc. These standards streamline billing and make the inquiries for eligibility and referral authorizations much easier.
The required transactions codes are:
- Health plan identifiers
- Country codes
- Employer identification number
- Provider taxonomy codes
Based on these standards, a transaction through HHS HIPAA is performed in following manner:
- A person is enrolled into a health plan and pays the premium on it.
- His eligibility is verified.
- His referral is authorized electronically or via phone or fax.
- A health care claim is made by the insured person.
- Bills and documents are submitted to prove the claim
- The claims are checked and verified.
- If there is no dispute, then the claim is remitted to the patient.
All the covered entities under are required to conduct electronic transactions for everything, including eligibility confirmation and sending claims through a clearinghouse.
HIPAA standards have made the task of managing and clearing health insurance claims really fast. It has also reduced the chances of human error or delay in delivery as all the data is now transferred electronically.
HIPAA or Health Insurance Portability and Accountability Act were created to give many rights to an individual regarding his medical records and private identifiable information.
HIPAA HHS is abbreviation for Health and Human Services (HHS) which is US Government’s Cabinet department. This department was created to protect health of every American and provide necessary human services to them. The motto of HHS is “Improving the health, safety, and well-being of America”. HHS was earlier called the Department of Health, Education, and Welfare, but was later renamed as Health and Human Service when its education branch was split in 1979 and was transferred to United States Department of Education.
This department was proposed in 1923, but could not be implemented at that time. Thirty years in line, Reorganization Plan Number 1 enacted this proposal. In 1979, HHS was made the supervisor of Social Security Administration agencies and it constitutes Family Support Administration and Public Health Service.
But in the year 1995, Social Security Administration was also split from HHS and turned into an independent entity.
HIPAA HHS is governed by Secretary of Health and Human Service. The Secretary is appointed with the advice and consent of Senate, by the orders of the President. Criminal activities which come under HIPAA HHS are investigated by the Office of Inspector General. The Office of Inspector General of HIPAA HHS investigates health care fraud of millions of dollars every year. Its multi-agency forces also cover all 50 States in America, plus District of Columbia which identify and investigate the people who deliberately avoid paying child support and prosecute them. Child Support Recovery Act makes it obligatory for parents to pay Child Support.
In 2003, HIPAA HSS published the final rule that had some modifications to the some rules which were published in 1998. The final rules of HHS focused on three concepts which were derived from Administrative Simplification language. The three concepts were:
- In order to cover every aspect of security, the standard should be coordinated and comprehensive.
- The standard should be easy enough to be implemented by all covered entities, regardless how big or small they are.
- The standard should be technologically flexible, so that future technologies can be easily adapted to them.