HIPAA

Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects health insurance coverage for workers and their families when they change or lose their jobs. It includes important new - but limited - protections for millions of working Americans and their families. HIPAA may:

• Increase your ability to get health coverage for yourself and your dependents if you start a new job;
• Lower your chance of losing existing health care coverage, whether you have that coverage through a job, or through individual health insurance;
• Help you maintain continuous health coverage for yourself and your dependents when you change jobs; and
• Help you buy health insurance coverage on your own if you lose coverage under an employer's group health plan and have no other health coverage available.

Among its specific protections, HIPAA:

• Limits the use of pre-existing condition exclusions;
• Prohibits group health plans from discriminating by denying you coverage or charging you extra for coverage based on your or your family member's past or present poor health;
• Guarantees certain small employers, and certain individuals who lose job-related coverage, the right to purchase health insurance; and
• Guarantees, in most cases, that employers or individuals who purchase health insurance can renew the coverage regardless of any health conditions of individuals covered under the insurance policy.

Title II of HIPAA is also known as Administrative Simplification. This is the portion of HIPAA that deals with:

• Establishment of a national standard for healthcare transactions (Transactions and Code Sets Rule).
• The healthcare Privacy Rule.
• The healthcare Security Rule
• Establishment of a national provider identifier.

The 17 faculty practice plans within the UB FPMP have all determined that, based on the definition of a covered entity under the HIPAA Administrative Simplification, they must abide by HIPAA. Further, as leaders in the healthcare community and educators of future healthcare providers, the UB FPMP, under the auspices of UBA are committed to complying with HIPAA and assisting with setting a Western New York healthcare community HIPAA standard.

The Central HIPAA Office of UBA has been charged with providing central guidance for all practice plans to create, implement and monitor HIPAA compliance. Further, UBA provides the practice plans with a Central Privacy Officer, Central Security Officer and Director of HIPAA Compliance. The Director of HIPAA Compliance works closely with a practice plan coordinator(s) to ensure compliance with HIPAA.

The Central HIPAA Officer regularly updates senior management as well as Practice Plan Presidents and the FPMP Governing Board on the status of HIPAA activities.

• Healthcare claims
• Healthcare remittance
• Insurance eligibility
• Claims status
• Referrals
• Coordination of Benefits
• Health plan enrollment
• Health plan premium payment

The UB FPMP utilize vendor supplied professional billing systems and/or services. As such, the practice plans are not involved in the re-programming of systems to comply with the new HIPAA TCS standards. Rather, the role of the practice plans, along with the leadership in the Central HIPAA Office it to work closely with all vendors and all insurance payors to migrate towards HIPAA compliant transactions.

Additionally, the Central HIPAA Office has convened a TCS subgroup comprised of representatives from the practice plans to read, evaluate and analyze the HIPAA TCS Implementation Guides in order to better understand the requirements of this aspect of HIPAA.

The UBA Central HIPAA Office currently fills the position of Privacy Officer for each of the practice plans as required by the HIPAA Privacy Rule. The implementation of the HIPAA Privacy includes:

• Comprehensive HIPAA Privacy policy, procedure and form manual, created specifically for the unique environment that the UB practice plans practice in.
• Centralized access to legal counsel with regards to HIPAA and particularly regarding Business Associates
• Comprehensive HIPAA Privacy Audit Tool that validates the Privacy implementation
• Access to the collective HIPAA resources for all 17 practice plans
• Centralized interface with the regions healthcare community and hospitals

The HIPAA Security Rule is the most recently finalized HIPAA Rule. The Central HIPAA Office currently fills the position of Security Officer for each of the practice plans. The Central HIPAA Office will:

• Create a comprehensive HIPAA Security policy, procedure and form manual.
• Perform regular HIPAA Security Audits
• Combine the HIPAA Privacy and Security manuals and audits into a comprehensive HIPAA Compliance Plan.
• Foster cooperative and joint initiatives on technology solutions.
• Interface with hospitals and other 'technology landlords' to ensure proper HIPAA Security implementation with other healthcare partners

The National Provider Identifier was recently finalized. The Central HIPAA Office will address the NPI Rule as time permits following the successful implementation of the HIPAA Security.

The compliance date for the NPI is 2007, while the system for generating and assigning the NPI is scheduled to be in place by 2005.

The Central HIPAA Office is involved in other HIPAA related activities. The Central HIPAA Officer currently co-chairs the WNY Workgroup for Electronic Data Interchange Strategic National Implementation Plan (WEDI SNIP) Regional Affiliate - UNYPHIED (www.unyphied.org ). In addition, the Central HIPAA Officer chairs the WNY Security Officers Forum and actively participates in the WNY Privacy Officers Forum. This involvement in the community provides access to the experiences of other covered entities and demonstrates the progressive HIPAA implementation plan of the UB Faculty Practice Plans.