Health insurance portability and accountability act
The Health Insurance Portability and Accountability Act (HIPAA)
Enacted in 1996, the HIPPA offers millions of American workers, protection which enhances portability and continuity of health insurance coverage. HIPPA offers protection to the workers and their families by way of:
(i) Restricting the exclusions for preexisting medical conditions
(ii) Offering to extend credit against maximum preexisting condition exclusion periods for prior health coverage and a procedure for providing certificates revealing periods for previous coverage to a new group health plan or health insurance issuer.
(iii) Offering new rights which permit individuals to enroll for health coverage while losing other health coverage, getting married or adding a new dependent.
(iv) Eliminating inequity in enrollment and in premiums charged to employees and their dependents basing on the health status linked factors
(v) Assuring availability of coverage of health insurance in case of small employers and renewability of health insurance coverage in case of both small and large employers.
(vi) Preserving the task of the state in imposing regulation in health insurance, inclusive of the states authority to provide greater protections compared to those available under the Federal law.
How does it work really
Let us suppose that somebody enrolls in a group health plan on January 1, 2006. Also let us suppose that this person had previously been under an insurance plan from January 1, 2004 till February 1, 2005 and again from August1, 2005 till December 31, 2005. In order to find out the amount of coverage that can be credited against the exclusion period under the new plan, we have to begin at the date of enrolment and count backward till a significant break in coverage is reached. Therefore the five months of coverage between August 1 2005 and December 31, 2005 evidently counts against the exclusion period. However, a little delving deeper will reveal that the period without insurance between February 1, 2005 and August 1, 2005 is more than 63 days. Therefore, this is a major gap in the insurance coverage, and any coverage before than it cannot be deducted from the exclusion period. Therefore, in this example, the person could subtract five months from his or her exclusion period, thereby reducing the exclusion period to seven months.
Eligibility conditions of HIPAA
To be eligible for HIPPA, a person must fulfill the following:
(i) An individual must have at least 18 months of continuous coverage without any major gaps
(ii) His recent insurance must be under a group plan
(iii) He must not be eligible for coverage under another group plan
(iv) His coverage must not have come to an end because of non-payment of premiums or insurance frauds
(v) He does not qualify either for Medicare or Medicaid
(vi) He purchased and used up COBRA, Temporary Continuation of Coverage, or State Continuation Coverage, in case they were offered to him.
(vii) It is important to note that a break in insurance coverage of 63 days or more will entail losing out on some of the HIPAA rights and protection.
Mandates of HIPA
It has been mandated by the HIPAA for the adoption of unique, uniform standards by every healthcare constituent:
(i) Attachments regarding health claims (ii) Status regarding Health claim (iii) Enrolment or leaving a health care plan (iv) Certificate of Referral and authorization (v) Eligibility in a health plan (vi) Coordination of benefits (vii) Payment of Healthcare proceeds and remittance advice (viii) Identifiers for service providers, payers, and also for patients (ix) Premium payments for health plans. (x) Set of codes (xi) First report of injury (xii) Privacy, confidentiality and security.
Benefits of HIPAA
HIPAA has been commended as a giant stride towards healthcare industrys vision of standardized health information collection and exchange. Whereas individuals, organizations and groups have been working towards the objective of health data standardization for several years, the federal mandate gave the basis for those important players to team up and develop the strategies and methodologies to ultimately attain administrative simplification. HIPAA has been willingly accepted by all fronts including service provider, payer, professional, employer, purchaser, and consumer sectors, having representatives coming from each sector and getting involved in the planning process at the national level.
The first concrete benefit under HIPAA has been the joining of forces of these diverse sectors of the healthcare industry on a public platform to share opinions and suggestions regarding the standardization of healthcare data, simplification of administrative procedures, and the protection of patent privacy. Across the formulation and development process, the national healthcare population has profited from this convergence of industry leaders who expressed their views on the positive and negative sides of HIPAA legislation. Besides in case of lot of others who have been benefited as a direct consequence of the HIPAA legislation, benefits which will be realized at once and give a permanent improvement to the delivery of health care in the United States.
The instantaneous benefits obtained by shifting to a standardized EDI environment comprise the following:
(i) The information which already resides inside the computer system need not be reentered once more and in this manner time is saved
(ii) Reducing the trouble locating information regarding a patient to perform patient care, finding out the eligibility, or settle a claim
(iii) Increasing the correctness and the utility of the data stored in the information system.
Benefits of HIPPA due to modern technology:
Because of the advent of computer technology, it has been possible for enabling secured storage and transmission of electronic health information. Data encryption, firewalls, and other security features permit a stage of security that exceeds much more than that offered by traditional paper records kept in conventional file cabinets. The regulations authorized by HIPAA will guarantee that organizations possess the much needed tools to safeguard patient information from misuse. Like Bank customers who perform electronic transaction through an ATM device, it is technology which safeguards their financial records, similarly in case of healthcare consumers, comparable safeguarding technology will be there.
Scope for further advancement:
Computer generated healthcare databases are vital for recording and capturing trends in the treatment and management of disease. Research professionals study healthcare data to study health outcomes, suggest an analysis of utilization and treatment patterns, promote breakthroughs in medical treatment and publish their research into clinical practice. But, researchers have faced bottlenecks because of incorrect applications of diagnostic and procedure codes and the problem of studying populations across varied non-standard systems. HIPPAs assurance of standardized datasets, coding and classification schemes implies that data generated across varied healthcare environments will have comparable content and thus can be networked, thereby giving researchers the capability to study diseases and treatment procedures cutting across populations and different settings.
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