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  What is HIPAA?  

wheelHIPAA stands for the Health Insurance Portability and Accountability Act of 1996. The earliest administrative simplification regulations of HIPAA became effective in 2002. It is a set of rules to be followed by doctors, hospitals and other health care providers to help ensure that all medical records, medical billing and patient accounts meet certain consistent documentation, handling and privacy standards.

HIPAA requires that all patients be able access their own medical records, correct errors or omissions, and be informed how personal information is shared and privacy procedures. The purpose is to provide standardized electronic transactions and to ensure the privacy and security of sensitive health information. HIPAA has National Provider Identifier for health related transactions enable electronic information to be sent and received more effectively. Some examples are the use of standard claim data by all insurers and the assignment of national identification numbers for providers that will be used by all insurers. Health plans must accept and return all data required by these standards and cannot request or return data not specified by the national standards.

Payers who conduct business electronically need to be aware of two significant standard transactions and code sets. On January 16, 2009, the Department of Health and Human Services announced two new compliance deadlines:

  1. The new version of HIPAA standards known as 5010 will become effective on
    January 1, 2012.
  2. ICD-10 codes will replace ICD-9 diagnosis codes for use in outpatient and inpatient settings and will replace ICD-9 procedure codes for inpatient settings beginning October 1, 2013. CPT codes will remain the codes used by physicians for reporting procedures in outpatient settings. Administrative Simplification is broken down into three main categories:


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