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Marketplace will help to enforce HIPAA

HIM Connection, January 28, 2003

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Dear Colleagues:

The marketplace can be a powerful means of enforcing regulations, especially when the regulations affect other businesses and the general public in such large measure as HIPAA's administrative simplification rules do.

The following list includes some of the major factors that could play significant roles in enforcement of HIPAA:

• Payment delays or denials may result when providers have not changed the way they submit claims, but the health plans they deal with have done made appropriate changes.
• Changes in ways that eligibility verification, authorization for services, claims status inquiries, and remittance advice are made available may encourage a provider to either adopt electronic transactions or risk delays in obtaining this information-potentially impacting staff productivity, claims denial, and cash flow.
• Business associates who do not have a business associate agreement with the provider may refuse to provide service because they fear downstream liability for exchanging information with a non-compliant provider.
• Disgruntled former or current members of the workforce may "test" the security (or lack thereof) of the provider's information systems.
• Well-intentioned members of the workforce may have a false sense of security because of HIPAA, and not realize that the provider is at risk because not all security standards have been met.
• A lack of privacy policies and procedures may result in breaches of confidentiality or denial of individual privacy rights, prompting a patient to file a formal complaint with the provider and/or the Secretary of HHS, or bring suit against the provider.
• Licensing and accrediting organizations may take a cue from HIPAA. JCAHO has already announced that it will place greater emphasis on security and privacy.
• Loss of competitive advantage may result from being slow to adopt the standards or to take advantage of opportunities created by HIPAA.

This week's HIM Connection was adapted from book, HIPAA Made Simple: A Guide to Fast-Tracking Compliance, Second Edition. This NEW edition has been updated to include privacy transactions and identifier changes. HIPAA Made Simple is geared toward helping to ease your workload in these demanding days of preparing for HIPAA compliance on top of all your other responsibilities. Click here for more information or to order your copy.

Sincerely,

Kim Raines
Managing Editor

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