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HIPAA Compliance

The American Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a set of rules to be followed by health plans, doctors, hospitals and other health care providers. One key provision requires health plans and providers to use standard formats for electronic data interchange, such as electronic claims submission EDI.

The HIPAA Privacy Rule took effect on April 14, 2003. Key privacy provisions include:

  • Patients must be able to access their record and correct errors
  • Patients must be informed of how their personal information will be used.
  • Patient information can only be shared if needed to treat the patient. In particular, it cannot be used for marketing purposes without their explicit consent.
  • Patients can ask their health plans and providers to take reasonable steps to ensure that their communications with the patient are confidential. For instance, a patient can ask to be called on his work number, instead of home or cell phone number.
  • Patients can file formal privacy-related complaints to the HHS' Office for Civil Rights.
  • Health plans or providers must document their privacy procedures, but they have discretion on what to include in their privacy procedure.
  • Health plans or providers must designate a privacy officer and train their employees.

The American Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a set of rules to be followed by health plans, doctors, hospitals and other health care providers. HIPAA took effect on April 14, 2003. In the health care and medical professions, the great challenge that HIPAA has created is the assurance that all patient account handling, billing, and medical records are HIPAA compliant.

Some provisions of HIPAA involve patient / hospital interaction. For example, patients must be able access their record and correct errors and must be informed of how their personal information will be used. Other provisions involve confidentiality of patient information and documentation of privacy procedures. It is these provisions that have led to regulation-specific software updates, specialist consulting, and in some cases complete overhauls of medical billing and records systems. If your organization is struggling in your efforts to comply with HIPAA consult the companies on this page who are some of the most reputable in the industry.