CLINICAL LAB SCIENEC

72
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
Health Insurance Portability and Accountability Act (HIPAA)
In 1996, an act of Congress established the Health Insurance Portability and
Accountability Act (HIPAA). This legislation took effect on April 14, 2002. In
reaction to intrusions into personal lives, the purpose of the legislation is to protect
the privacy of patients’ health information and records.
In the past, many agencies such as health care insurers had routinely purchased
or otherwise obtained individual patient records to determine premium
charges based on medical conditions or to deny insurance coverage for certain
patients and their families. Also, commercial efforts for mass distribution of contacts
and for companies that wanted to establish a base of customers and private
information for sale to certain businesses had become prevalent.
HIPAA regulations protect medical records and other individually identifiable
health information, whether on paper, in computers, or communicated
orally for recording. There are also offshoots of this legislation affecting institutions
other than the health care industry. One example of this is the Family
Education Rights and Privacy Act (FERPA), which provides students with certain
rights with respect to their educational records. It is designed to protect
the records of students enrolled in any training or educational institution and is
designed to protect the privacy of individual students. The rules for FERPA are
similar to those of HIPAA.
Although HIPAA was the first attempt to protect private information, others
will surely follow, to establish federal privacy standards to protect patients’ medical
records and other health information provided to health plans, physicians,
hospitals and other health care providers. The plan was developed by the U.S.
Department of Health and Human Services (HHS), and in addition to protecting
patient records, provides patients with a process for accessing their own medical
records and gives them more control over how their personal health information
is used and disclosed. A consistent format is provided for privacy protections for
consumers of medical care throughout the nation. In instances where current
state laws already provide protection, or are more stringent than federal law , the
state laws are not affected by the federal law.
In 1996, Congress asked HHS to provide a plan for patient privacy protections
as part of HIPAA. As a means to transfer health information from provider
to provider, and for insurance reimbursement, HIPAA encourages electronic
transactions and provides requirements to safeguard the security of health care
information when sharing that information between medical facilities and any
agency with a need to acquire individual patient records. Health insurance plans,
including health maintenance organizations (HMOs) and preferred provider
plans (PPOs), and health care providers of all types have a mammoth task in
protecting the privacy of patients and other consumers of health care.
Maintenance of records may be contracted to a company that specializes in
the storage and disseminating of medical records to third parties. For efficiency
and economy, there are health care clearinghouses that specialize in maintaining
medical records for large institutions as well as for other medical care providers
by providing financial and administrative transactions. Duties such as collecting
enrollment information, billing of patients and plans, and ensuring eligibility for
Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.