Successful Relief For The Headache Potential of HIPAA
To assist our clients with HIPAA compliance, GTESS has implemented
a dual approach, ensuring: 1) its own HIPAA readiness, and 2)
the facilitation of client compliance. Our core workflow system
provides clients with the electronic transfer of information,
enabling format standardization for healthcare information management
claim processing. Additionally, our document management solution
allows faster and easier compliance with the privacy standards.
Of course, as a healthcare “business associate,” our
own HIPAA compliance is always top-of-mind.
Transaction Standards — GTESS is on the forefront
of the efforts to convert from non-standard to standard formats
for electronic claims and encounters, and the conversion of paper
forms to electronic format for the ease of transmission between
covered entities and business associates. Privacy Standards — GTESS has engaged in a comprehensive
organizational effort to ensure compliance with state and HIPAA
privacy regulations. The efforts of GTESS to comply are fully
documented and are made available to our clients for their review
and satisfaction that GTESS provides satisfactory safeguards.
Security Standards — GTESS has taken reasonable
and industry acceptable efforts to ensure the safety of protected
healthcare information, consistent with the NPRM on Security regulations.
GTESS intends to fully comply with the finalized security regulations
regarding healthcare information management.
HIPAA Background:
The Health Insurance Portability & Accountability Act
of 1996 (August 21), Public Law 104-191 (HIPAA) was passed by
Congress to reform the insurance market and simplify healthcare
administrative processes. HIPAA requires improved efficiency in
healthcare delivery by standardizing electronic data interchange,
and ensuring the privacy and security of protected health information
through the establishment of regulations and standards. The administrative simplification provisions of HIPAA are intended
to reduce the number of forms and methods of completing health
insurance claims and other payment-related documents, and to implement
the use of standardized code sets and universal identifiers. Another
goal is to increase the use and efficiency of electronic exchange
of standard healthcare information. The five specific areas of
healthcare information management simplification addressed by
HIPAA are:
1. Electronic Data Interchange (EDI) — This is the
electronic transfer of healthcare information in a standard format
between trading partners. It allows partners to exchange information
and transact business in a fast and cost-effective way. The transactions
that are included within HIPAA consist of standard electronic
formats for enrollment, eligibility, payment and remittance advice,
medical claims claims, health plan premium payments, health claim
status, and referral certification and authorization.
2. Code Sets — These include data elements used
to uniformly document the reasons why patients are seen and what
is done to them during their healthcare encounters (procedures).
3. Identifiers — These are numbers used in the administration
of healthcare to identify healthcare providers, health plans and
employers. Over time, this is intended to simplify administrative
processes (such as referrals and billing), improve accuracy of
data and reduce claim processing costs.
4. Privacy — These regulations provide: 1) standards
for the use and disclosure of protected health information, (2)
the implementation requirements, and (3) individual rights related
to consent, authorization, restrictions, access, amendment and
accounting of protected health information.
5. Security — Standards need to be developed and
adopted for all health plans, clearinghouses and providers to
follow and to be required at all stages of transmission and storage
of healthcare information to ensure integrity and confidentiality
of the records at all phases of the process — before, during
and after electronic claims processing.
HIPAA Benefits: The benefits of HIPAA include lowering claim processing and
administrative costs, enhancing the accuracy of data and reports,
increasing customer satisfaction, reducing cycle time and improving
cash management.
Covered entities that are directly affected by HIPAA regulations
include:
1. Healthcare providers
2. Healthcare payers
3. Healthcare clearinghouses
HIPAA also affects business associates who perform services
or receive protected health information from any of these types
of entities. Almost everyone who is involved in healthcare will
be affected by HIPAA regulations.
Notice of Privacy practice
- GTESS Corporation
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