HIPAA Basics

Overview

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted as part of a broad Congressional attempt at incremental healthcare reform. Signed into law on August 21, 1996 by the Clinton administration, HIPAA is considered to be the most significant body of health-care legislation to be enacted since Medicare. HIPAA is made up of several provisions designed to protect the healthcare consumer in a number of ways – many of which are still not in effect. At a high level, HIPAA legislation includes the following:

 

Title I: Insurance portability – helping workers and their families maintain insurance coverage when they change or lose a job.
Title II: Administrative simplification – providing legislation around privacy, security and electronic data.
Title III: Tax-related provisions – allowing employees to set up medical savings accounts.
Title IV: Enforcement of group health care requirements.
Title V: Revenue offsets – for company-based life insurance plans.
Title II: Administrative simplification – providing legislation around privacy, security and electronic data.

Administrative Simplification

It is HIPAA’s Title 2 legislation for Administrative Simplification that is of greatest importance to Medical Office Online's Clients especially, the legislation concerning electronic data. The following table shows the four areas in which the provisions for electronic data are divided.

Transactions
and
Code Sets

Standards for the Electronic Data Interchange (EDI)of healthcare information from one company to another for a specific purpose.

Code Set standards are for any coded information within a transaction, i.e. diagnosis codes, procedure codes, inpatient services codes, and drug codes.

More Info:
Electronic Transaction FAQ’s
Final Rule (HTML)
Final Rule (PDF)
Implementation Guides
(free download)
Strategic National Implementation Process

Code Set FAQ’s

Privacy Standards designed to protect an individual’s identifiable health information from unauthorized disclosure or use in any form, whether communicated or maintained electronically, on paper, or orally. More Info:
Privacy FAQ’s
Final Privacy Rule (Preamble)
Final Privacy Rule (Regulation Text)
Security Standards requiring that specific procedures and methods be implemented to protect individually identifiable health information
from loss or inappropriate disclosure. These requirements are designed to be technologically neutral and scalable.
More Info:
Security FAQ’s
Proposed Security Rule (HTML)
Proposed Security Rule(PDF)
Proposed Security Rule (TXT)
 
Identifiers Dep. of Health and Human Services (HHS) established Uniform Identifier Standards, which are national standards of identification for use on all claims and other data transmissions. Included are an Employer Identifier Number (EIN), National Health Plan Identifier (PlanID), a National Provider Identifier (NPI), and a Unique Healthcare ID for Patients (UHID).

More Info:
NPI FAQ’s
Proposed NPI Rule (HTML)
Proposed NPI Rule (PDF)
Proposed NPI Rule
(TXT)

EIN FAQ’s
Proposed EIN Rule (HTML)
Proposed EIN Rule (PDF)
Proposed EIN Rule
(TXT)

 

HIPAA and MOO page
HIPAA Links

The content presented within this section is merely a brief overview of HIPAA—an expansive and detailed piece of legislation—and should not be used in place of your own legal council.