Guest guest Posted May 22, 2003 Report Share Posted May 22, 2003 Is Your Office HIPAA Exempt? Quick Checklist Here is a quick check list that determines whether a physician/provider is a HIPAA entity or HIPAA-free. Importantly, it can be more than just doing electronic claims. Only one "Yes" categorizes you as a HIPAA entity: YES NO Do you perform electronic transactions with others (beyond your office) for: __ __ Health care claims and/or equivalent encounter information? __ __ Health care payment and/or remittance advice? __ __ Coordination of benefits? __ __ Health claim status request and response? __ __ Health plan enrollments and disenrollments? __ __ Health care eligibility benefit inquires and responses? __ __ Health plan premium payments -payment order or remittance advice? __ __ Referral certification or authorization - request for review and response? YES NO Other situations or mandates: __ __ Have you retained another entity (billing service or clearing house) to conduct electronic transactions for you? __ __ Have you signed an agreement/contract to be a HIPAA Entity (e.g. insurance payers) ? __ __ Do you live in a state which mandates HIPAA status to every provider by law ? (e.g. Texas) __ __ Do you see Medicare patients and have more than 10 full time equivalent employees? Medicare Mandate Exceptions Small offices can be exempt from HIPAA electronic mandates. According to definition by law (Section 3 of H.R. 3343), “small providers” are: (i) physicians, practitioners, facilities, or suppliers with fewer than 10 full time equivalent employees, or(ii) providers of services, such as hospitals, skilled nursing homes, or Ambulatory Surgical Centers (ASCs) with fewer than 25 full-time equivalent employees. A ChiroCode subscriber recently received the following communication from HHS: "Thank you for your question. As a non-covered entity (provider that has fewer than 10 full time employees and is not currently conducting electronic transactions) you are waived from complying with ALL aspects of HIPAA, including Privacy. Its either you do it all or do nothing. Therefore, continue to do business as you have done in the past, however, make sure that you stay abreast of HIPAA so that in the event you become a covered entity or you work with covered entities, you are up to speed on its requirements." Fortunately, this exemption applies to many chiropractors (solo and small groups). It keeps the small office from being forced in the HIPAA compliance standards arena. Please note the following excerpt from a recent memo from our legal counsel: “The HIPAA privacy standards (as well as the HIPAA security and standard transaction rules) apply only to "covered entities." A covered entity is defined as a health care clearinghouse, a health plan, or those health care providers who submit information in electronic form in connection with a transaction covered by the HIPAA standard transaction rules. 45 C.F.R. §160.103. “If a health care provider does not undertake an electronic HIPAA standard transaction, the health care provider is not covered by the rule.“For example, if a health care provider submits all claims in paper format, the health care provider would not be subject to the HIPAA standards (unless there was another standard transaction being conducting electronically). Health care providers will be considered covered entities when they undertake at least some electronic billing.”-Bill Sarrille, Arent Fox, Washington DC State Law Exceptions It is interesting to note the Texas law (SB-11) which typifies this omnibus HIPAA program. It states that anyone in Texas who sees or handles Protected Health Information is subject to HIPAA (PHI). Dr Rick Gillespie from Texas aptly commented, "It will probably be years before the bugs are ironed out of this little beaurocratic hatchling. The scary thing is, some innocent doc could be made an example of and be forced to pay dearly." Dr Gillespie's assessment is highly probable because the compliance squads are to be paid from generated revenues.Doctors and Providers can be assured of two HIPAA realities:1) It is a benign little "hatchling" today which only requires a "good faith" efforts towards compliance in its infancy.2) It will surely grow into another monolithic beaurocracy . HIPAA-Free Certificate If you are HIPAA-exempt, download a HIPAA -Free Certificate to display in your office. You must have Adobe Acrobat Reader installed on your computer to view forms. Click below to download the current version (FREE). If you experience difficulties, please send a self-addressed stamped envelope to have the forms mailed to you. State which form(s) you would like to receive.Address it to:ChiroCode Institute7315 North 16th St. Ste. 200Phoenix AZ85020-5261 Bookstore • About Us • Contact Us • Links • Home © ChiroCode Institute, Inc. 2003 Copyright & Disclaimer | Privacy Policy Quote Link to comment Share on other sites More sharing options...
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