HIPAA Update - PowerPoint PPT Presentation

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HIPAA Update

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Title: PowerPoint Presentation Last modified by: Donna.Eden Created Date: 1/1/1601 12:00:00 AM Document presentation format: On-screen Show Other titles – PowerPoint PPT presentation

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Title: HIPAA Update


1
HIPAA Update
  • Donna Eden
  • Office of General Counsel, HHS
  • Donna.Eden_at_hhs.gov

2
Update Issues
  • Transactions modifications
  • Other regulations
  • Covered entities
  • Clarifications

3
Transactions Modifications
  • Modifications published.
  • 600 comments received
  • Finals out as soon as possible

4
Other Regulations
  • Finals in process
  • Security
  • National Provider Identifier
  • NPRMs in preparation
  • National Payer Identifier
  • Attachments
  • ASCA Waivers and Exclusions
  • Next Transactions modifications

5
Covered Entity
  • Statute applicable to three groups
  • Plans
  • Providers
  • Clearinghouses
  • Function, not name
  • Possible to have multiple functions
  • Choice only for PROVIDERS

6
Covered Entity Questions
  • Status applicable to all HIPAA regulations
  • Flow charts coming!
  • Hybrid entity status
  • See clarification in Privacy Rule modifications
  • Either component or parent may file ASCA plan

7
Small Health Plans
  • HIPAA gives one year extension to small health
    plans for compliance with standards
  • Definition at 45 C.F.R. 160.103 annual receipts
    of 5 million or less.
  • Meaning of receipts for ERISA group health plans
  • Fully insured
  • Self-funded
  • Mixed

8
Small Provider
  • Not initially defined by HIPAA
  • Defined by ASCA
  • Institutional provider with fewer than 25 FTEs
  • Practitioner with fewer than 10 FTEs
  • Applies ONLY for waiver from ASCA requirement to
    file Medicare claims electronically after October
    16, 2003

9
Clarifications
  • More than privacy and transactions
  • More than Medicare and Medicaid
  • HIPAA and
  • Financial activities
  • ERISA plans
  • Fraud and abuse
  • FERPA

10
Questions?
  • New FAQ site
  • www.cms.hhs.gov/hipaa
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