HIPAA ADMINISTRATIVE SIMPLIFICATION

The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. The HIPAA Administrative Simplification’s objective is to design, develop, test and successfully implement standard transactions and code sets for the electronic exchange of administrative and financial health care transactions. October 16, 2002 is the implementation date for this regulation.

Who must comply?

1. Providers
2. Clearinghouses
3. Health Plan Organizations

What is included in Administrative Simplification?

1. Electronic Data Interchange (Transactions)
2. Medical Code Sets (procedures & diagnoses)

a) CPT

b) HCPCS

c) ICD-9-CM

d) NDC Drug Codes

e) Revenue Codes

f) Modifiers

3. Unique Health Identifiers
4. Privacy and Security Standards

*For a complete list of the rules and current status, please refer to http://aspe.os.dhhs.gov/admnsimp/

What must I do to become HIPAA compliant?

1. Read the final rules.
2. Download the implementation guides.
3. Perform a gap analysis. (Compare data in guides to your current operations.)
4. Develop a work plan to address the issues that are contrary to the guides.
5. Educate your work force and get them involved in the HIPAA compliant initiative.

Consult these informative web sites.

http://aspe.os.dhhs.gov/admnsimp/ -- Administrative Simplification

www.ncvhs.hhs.gov -- Nation Council on Vital & Health Statistics

www.hl7.org -- Health Level 7 for the exchange of key sets of clinical and administrative data.

www.ncpdp.org -- Responsible for developing retail drug standards.

www.wpc-edi.com -- Implementation guides for proposed standards.

www.ama-assn.org -- American Medical Association

www.disa.org -- Supports the Accredited Standards Committee responsible for developing transaction and code set standards.