What Is HIPPA And What Is Its Purpose. The Health Insurance Portability and Accountability Act, or HIPAA, was signed into law by President Clinton in 1996. The primary goal of HIPAA from a consumer standpoint is to protect private healthcare-related information to prevent abuse via fraud and identity theft. Most people have only dealt with HIPAA when at a medical appointment when they have been required to sign paperwork that limits access to their medical information. However, HIPAA relates to medical coding and billing organizations as well because they are also responsible for maintaining compliance with privacy laws that protect patient rights.

HIPAA requirements for healthcare providers and their staff exist for the safeguard of private and sensitive patient information and, as such, have a notable impact on medical coding and billing. They have an impact because coding and billing specialists transfer much of that information to other parties in the payment cycle.

HIPAA is structured as five subgroups called titles. Title I of HIPAA addresses healthcare access, portability, and renewability; while Title II deals with preventing healthcare fraud and abuse, administrative simplification, and medical liability reform. These most specifically relate to the healthcare reimbursement process for which medical coding and billing specialists are responsible.

Title I of HIPAA mainly addresses health insurance issues. It provides protection of employer-provided* health insurance coverage for workers and their families and allows access to healthcare during lapses in coverage due to a job change or job loss. Further, it limits health insurance companies so they are limited in their restrictions related to benefits and premiums for preexisting health conditions, and so they cannot deny coverage without cause—it includes provisions that guarantee the renewability of insurance plans. Insurers are required to renew coverage to all groups, regardless of the health status of any group member with some exceptions including nonpayment of premiums. (*HIPAA’s Title I does not apply to insurance plans paid for by individuals. Those plans are addressed by the Affordable Care Act.)

Title II of HIPAA establishes security and privacy protections for patient health information. It sets standards for electronic health care transactions, requiring all providers and medical billers under HIPAA to submit claims electronically using a specifically approved format for transfer. Title II describes standardized medical codes under the Security Rule and clarifies the Electronic Data Interchange (EDI) form that medical coding and billing specialists use to send claims electronically, depending on the specific type of transaction. (There are also set standards for how providers must interact with their patients and how they must safely store private or sensitive information related to their patients under the Privacy Rule.) 

What Is HIPPA And What Is Its Purpose. The purpose and implementation of HIPAA is to monitor the flow of medical information and protect the most private and sensitive elements, to ensure that it is only accessed by those who legitimately need to do so. Quick Claimers Medical Billing knows healthcare providers take seriously their ability to focus on patient care while ensuring their personal health information is protected from parties unauthorized to access it. By providing secure medical coding and billing services, the specialists at Quick Claimers can give healthcare providers the freedom to focus on providing quality care that their patients need and deserve. Contact Quick Claimers via their website or email, or call them at 915-351-6600. Quick Claimers Medical Billing is ready and waiting to help you with your coding and billing needs!