HIPAA Implications for Medical Coding Specialist - Research Paper Example

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HIPAA Implications for Medical Coding Specialist Author’s Name Institution Abstract HIPAA was enacted in 1996 as a provision to improve the affordability, quality and access of health services in the US. It is aims at protecting the patient’s privacy right while allowing the flow of information…
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HIPAA Implications for Medical Coding Specialist
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"HIPAA Implications for Medical Coding Specialist"

Download file to see previous pages It will further elaborate the provisions in the Act for which the coding specialists are expected to follow. The adoption of the Health Insurance Portability and Accountability Act (HIPAA) in 1996 has brought various changes in the health sector. The Act was aimed at improving accessibility, affordability and quality of health services in the USA. It is made of several titles, which addresses various issues in the health sector. The Administrative Simplification provision, Title II, requires the Department of Health and Human Services (DHHS) to institute national rules that govern the transfer of electronic information in the health sector. It also necessitates that department to establish national identifiers for the health plans, providers and employers who participate in the health sector (Centers for Medicare and Medicaid Services 2012). Currently, the adoption of HIPPA rules has encouraged the use of electronic data interchange. The Act identifies various entities, so called covered entities, which are expected to comply with the provisions of the act. These include health plans, health care providers and clearing houses (CMMS 2012). These entities are expected to certify their compliance to the rules. Failure to certify and comply with HIPAA regulation will attract a preset penalty. This paper will seek to elaborate the implications of HIPAA to the medical coding specialist. ...
The title requires the adoption of the following rules: privacy and security standards, transactions and codes as well as unique identifiers. Failure to comply with these standards will carry substantial penalties, which may include criminal and monetary penalties (Krager & Krager, 2008). The Act has identified various entities, which are expected to comply with these provisions. These are referred to as the covered entities. They include health care providers, health plans and health care clearing house (CMMS, 2012). The health care providers are those who transmit health care information related to specific transactions. They include doctors, pharmacies, dentists and nursing homes. Health plans are individuals or groups that pay the cost of the medical services. These include community health plans, health insurance companies and government programs that cater for medical costs, for example, Medicare. A health care clearing house processes non standard information received from other health care entities to standard formats. Information is transmitted electronically from the health providers to the health plans using various different formats. Previously, the health sector used more than 400 different formats in transmission of these data. HIPAA dictates that information should be transmitted using standard formats. These helps reduce the administrative costs used in handling the information. HIPAA introduced the Electronic Data Interchange (EDI) formats used for transmission of information between the covered entities. Under this act, code sets refers to codes used to identify various data elements. These include diseases, cause of injury, impairments, supplies, equipments or other items used in the ...Download file to see next pagesRead More
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...the same health care transactions, code sets and identifiers. The HIPAA standards for electronic data interexchange (EDI) is applicable to claims and claim status, encounter information, payments and remittance, inquiries, referral certification and authorization, enrollment or disenrollment in a health care plan, premium payments, claim benefits and attachments (Privacy and Security, n.d). In addition to these standards code sets are used in claim forms for identification of specific diagnosis and clinical procedures, encoding table terms and medical concepts (Privacy and Security, n.d; Frequently Asked Questions, 2000). In the healthcare industry codes...
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