ICA Member News Update              

    August 2, 2004

 

 

HIPAA CHANGES AND NEW REPORTING MECHANISMS

IMPORTANT TO ALL HEALTH PROFESSIONALS

 

Although things have been relatively quiet with the federal Health Care Portability and Accountability Act (HIPAA) confidentiality regulations, no one in health care should believe that the HIPAA program has been inactive, or that careful attention to the details of the HIPAA requirements are no longer important.    New on-line complaint mechanisms have been launched by the US Department of Health and Human Services (HHS), and the HHS Office of Civil Rights has stepped up its communications with consumer and senior citizen groups to educate and mobilize citizens to help monitor HIPAA compliance.   Federal regulations published in April, 2003, establish civil monetary penalties for HIPAA violations, and providers in violation can face fines of $100 per violation, up to a maximum of $25,000 per calendar year.

 

 

NATIONAL PROVIDER IDENTIFIER (NPI) NUMBER

RULES TO TAKE EFFECT IN MAY, 2005

 

The administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L. 104-191) require the Secretary of Health and Human Services to adopt a national standard identifier for health care providers for use in the health care industry.     The Centers for Medicare and Medicaid Services (CMS) adopted the National Provider Identifier (NPI) as the standard identifier.  HHS has published the final rules for this standard unique health provider identifier number program that is scheduled to become operative on May 23, 2005.  Providers can begin applying for NPIs on May 23, 2005, and all health care providers are eligible to be assigned NPIs.  All HIPAA covered "entities" and professionals providing services in all federal programs, including Medicare and Medicaid, must obtain and use an NIP number.  All HIPAA covered entities will be expected to use NPIs by the initial compliance date of May 23, 2007, and "small health plans" by May 23, 2008. 

 

The NPI requirement is scheduled to supersede all other numbers for providers in terms of claims filings, though entities may elect to use other types of provider numbers for internal purposes.  According to the HHS announcement:

 

"Upon the compliance dates, only the National Provider Identifier (NPI) may be used for identification purposes for a health care provider in standard transactions; legacy identifiers (such as the Unique Physician Identification Number (UPIN), Medicaid Provider Number, Medicare Provider Number, and others) may not be used. Where a health care provider must be identified in standard transactions for tax purposes, it would use its Taxpayer Identifying Number as required by the implementation specifications. Health care provider identification numbers other than the NPI may continue to be used in the internal processes and files of health plans or health care clearinghouses if they wish to continue to use those identification numbers in those internal processes and files."

 

 

NEW HIPAA VIDEO AVAILABLE

 

A new instructional video entitled "HIPAA 101 (Health Insurance Portability and Accountability Act of 1996): The Basics of HIPAA Administrative Simplification" is now available from HHE for a fee of $13.00 from the   National Technical Information Service in Springfield, Virginia 22161 by calling (703) 605-6000.  This program was designed to inform the health care provider community about the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 or HIPAA. It will help you understand: the history of HIPAA and its benefits; how to tell if you are a 'covered entity' under HIPAA; the standards that have been adopted for electronic transactions and code sets; why the Designated Standards Maintenance Organizations may be important to you; what you need to do to be compliant with the administrative simplification provisions of HIPAA; and how HIPAA's rules and deadlines will be enforced.

 

 

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For More Information: Contact the International Chiropractors Association at:  chiro@chiropractic.org or visit the ICA website at www.chiropractic.org. 

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