The Role of HIPAA in Health Care Organization - Research Paper Example

It was also designed to prevent employers from hiring persons due to medical conditions that may affect the cost of their job-related group insurance. Under its rules, there is a six-month limit for denying coverage for preexisting conditions under employer-provided health plans.  Specifically, unless an employee has received diagnosis or treatment for a pre-existent condition within six months prior to being hired then they cannot be denied coverage for the issue (http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html).

A secondary purpose of HIPAA is to protect patient confidentiality.  It regulates who can access medical records, the reasons they may do so, and the proper they follow. In most cases, it forbids individuals or organizations from looking at a person’s records without their permission.

HIPAA must be followed for ethical as well as legal reasons.

Because of its importance, a wide variety of health care and insurance professionals must be trained in HIPAA compliance. Training is offered in several formats, including online.  The website http://www.ehipaatraining.com/ offers Internet-based classes on the subject. The Department of Health and Human Services offers similar resources on the web page, www.hhs.gov.

One activity that HIPAA regulates is how medical service providers must apply for insurance payments. Special software packages have been designed to ensure that this is done in accordance with HIPAA’s requirements. Those requirements are subject to periodic revisions.

For example, by January 1, 2012, electronic transmissions must be compliant with HIPAA’s version 5010 standards. Hospitals and physician’s offices across the country are busy making sure they will be ready by this deadline (http://blog.mgma.com/blog/bid/59934/Vendor-practice-relationship-crucial-for-meeting-new-HIPAA-standards).

HIPAA is enforced by the Office of Civil Rights (OCR). Persons who believe their rights under HIPAA have been violated may file a complaint with this organization. The grievances are reviewed for merit, and action is taken accordingly. If the OCR proceeds, both the complainant and the suspect entity are notified of the upcoming investigation. OCR officials gather information about the incident and rule on the matter. If a determination is made that the accused party did in fact violate HIPAA rules, then a hearing will determine what corrective actions need to be taken.  Sometimes a commitment to future compliance is all that is mandated. In other instances, monetary fines may be imposed, or the case might be referred to legal authorities for criminal prosecution (http://www.hhs.gov/ocr/privacy/hipaa/enforcement/process/howocrenforces.html).

In HIPAA terminology, PHI refers to protected health information.  It is what the privacy act is designed to safeguard. The privacy act also sets guidelines for how service providers may obtain payments for their services.