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NEW! H.J. Ross' Interactive HIPAA Administrative Compliance Manual
 Personally walks you and your chiropractic office on a guided tour through the compliance process, requiring no special training and allowing you to create customizable office policies and procedures. Request a free demo here.
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 ACA makes HIPAA compliance easy! Click here for sample compliance forms that you can customize for your own office needs. |
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The Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191), also known as HIPAA, is a law with various components relating to the delivery of health care, including, but not limited to, fraud and abuse, insurance portability, and administrative simplification that encompass electronic transmission of claims and medical records privacy. HIPAA is administered through the Centers for Medicare and Medicaid Services (CMS) an agency of the U.S. Department of Health and Human Services (HHS). Here you will find the latest news, background information, and resources to assist you in managing this critical aspect of your practice. |
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| National Protection Identifier Final Rule Published |
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The Final Rule adopting the HIPAA standard unique health identifier for health care providers was published in the Federal Register on January 23, 2004. Health care providers can begin applying for NPIs on the effective date of the final rule, which is May 23, 2005. All health care providers are eligible to be assigned NPIs; health care providers who are covered entities must obtain and use NPIs. All HIPAA covered entities must use NPIs by the compliance dates (May 23, 2007 for all but small health plans; May 23, 2008 for small health plans).
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Please consult with your legal counsel and state associations for state specific laws and regulations. In general, state laws that are contrary to the Privacy Rule are preempted by the federal requirements, which means that the federal requirements will apply. "Contrary" means that it would be impossible for a covered entity to comply with both the state and federal requirements, or that the provision of state law is an obstacle to accomplishing the full purposes and objectives of the Administrative Simplification provisions of HIPAA.
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| Administrative Simplification: Electronic Transmission of Claims |
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The definition of a "covered entity" under HIPAA is as follows: "health plans, health care clearinghouses, and health care providers who transmit health information in electronic form in connection with any transaction referred to in section 173(a)(1) of the Act." (45 CFR §164.104). The transactions referred to in this act include electronic billing, coordination of benefits and checking the status of claims. A provider who is a "covered entity" must also comply with the Privacy and Security Rules.
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| Administrative Simplification: Privacy Rule |
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As mandated by law, HIPAA established the Standards for Privacy of Individually Identifiable Health Information, also known as the Privacy Rule. The rule created national standards to protect individuals' medical records and other personal health information. It covers health plans, health care clearinghouses, and those health care providers who conduct certain financial and administrative transactions electronically, such as electronic billing and fund transfers. Included here are resources from the Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR).
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