HIPAA
Compliance Rule Standards
HIPAA compliance can be
summarized by the three major rules or standards:
HIPAA Privacy Rule
The HIPPA Privacy Rule mandates the protection and
privacy of all health information. This rule
specifically defines the authorized uses and disclosures
of "individually-identifiable" health information.
HIPAA Transactions and Code
Set Rule
The HIPPA Transaction and Code Set Standard addresses
the use of predefined transaction standards and code
sets for communications and transactions in the
health-care industry.
HIPAA Security Rule
The HIPAA Security Rule mandates the security of
electronic medical records (EMR). Unlike the Privacy
Rule, which provides broader protection for all formats
that health information make take, such as print or
electronic information, the Security Rule addresses the
technical aspects of protecting electronic health
information. More specifically, the HIPPA Security
standards adresses these aspects of security:
» Administrative security
- assignment of security responsibility to an
individual.
» Physical security - required to protect
electronic systems, equipment and data.
» Technical security - authentication &
encryption used to control access to data.
HIPAA
Definitions
Covered Entity
Any business entity that must comply with HIPAA
regulations, which includes health-care providers,
health plans and health-care clearinghouses. For
purposes of HIPAA, health-care providers include
hospitals, physicians and other caregivers.
CPT - Current Procedural
Terminology
A 5-digit code used in medical billing and records
systems that defines the medical procedures and medical
services provided.
EMR - Electronic Medical
Record
A computer-based medical record for a patient that
provides secure, real-time data access, sharing and
evaluation for medical care. Also called an electronic
health record or electronic patient record.
HCFA 1500
A medical billing form used by doctors to file insurance
claims for medical services.
HCPCS - HCFA Common
Procedural Coding System
A medical coding system used to describe what treatment
or services were provided by a physician. The HCPCS
Level II Coding books contain codes and descriptions for
durable medical goods, injections, supplies and services
not listed by CPT Coding books.
HL7 - Health Level Seven
A data exchange protocol and interface for medical
records and billing software that allows different
systems to interoperate.
HIPAA - Health Insurance
Portability and Accountability Act
A body of national standards for electronic medical
records and transactions for healthcare providers,
health plans, and employers. It also addresses the
security and privacy of electronic health records.
ICD-9 - International
Classification of Diseases, 9th Edition
A numerical code used in medical billing describing a
diagnosis or medical procedure to treat a disease,
syndrom or disorder. |
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