HIPAA

HIPAA

HIPAA

Introduction

The main purpose of the HIPAA was to ensure that when employees left a job they would not lose their health insurance coverage. However, during the legislative process, the Administrative Simplification title of the act was passed; this part of the act requires the nation to be more efficient in processing health claims through electronic transactions (Rothstein). Foreseeing that individuals would be concerned about the ability to share their health information instantly nationwide, this title also attempted to guard the health information privacy in these electronic transmissions (Rothstein).

Rothstein noted that, as a result of this concern, HIPAA specified that Congress would write additional legislation within two years to address the privacy issues; however, failing to do so would relegate the task to the Department of Health and Human Services (DHHS). Rothstein pointed out that Congress subsequently failed to enact new legislation dealing with privacy, so DHHS disseminated the final privacy regulations. These regulations went into effect on April 14, 2001; however, compliance for almost all of the involved entities went into effect on April 14, 2003.

Rothstein (2005) noted that the passage of the HIPAA regulations has caused much confusion among the health care community; he blamed some of this confusion on the lack of resources and the lack of education that needed to be directed to those who would be involved in the implementation of the new rules. Rothstein explained some of the misconceptions regarding the Privacy Rule and to whom the rule applies.

Rothstein (2005) expounded on the areas in which the Privacy Rule and the Common Rule differ. Starting with the purposes and the oversight divisions, Rothstein indicated that the Privacy Rule is concerned with the safeguarding of the privacy of individuals and disclosure of PHI by those entities covered by the act; he noted that alleged violations are handled by the DHHS Office for Civil Rights. The Common Rule's purposes are the safeguarding of human welfare during research, and the privacy and confidentiality of their information; the alleged violations of this rule are investigated and handled by the institutional review board (IRB) of the institution in which the research is being conducted.

How HIPAA Violations Affect the Medical Billing Process

The preparation of HIPAA's laws requires a significant amount of investment to provide facilities that are more efficient and the government is cutting reimbursement through the Balanced Budget Act and Ambulatory Payment Classifications. Significant fines plus imprisonment and other harsh civil and criminal punishment will be faced by the organization if the rules set up in HIPAA are breeched or not properly followed by any organization or responsible party. In addition, some disciplinary action will be taken by the Board of Nurse Examiners against such clients and organizations that violate the laws of HIPAA (Brown, 2006).

The Common Rule allows the subjects in a research study to extract themselves from the research at any time, and further research involving them is not allowed. However, the Privacy Rule is less strict on regulations regarding prior authorization and withdrawing from a ...