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Weekly Overview

Week Five

Overview

Week Five will introduce you to Electronic Data Interchange (EDI) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). EDI is used in health care to standardize electronic transactions so that electronic information being sent from one computer system to another will be the same. EDI is comprised of eight transactions, each of which are mandated by HIPAA.

HIPAA was enacted by Congress in 1996 to address the security and privacy of patient health information. HIPAA protects a patient’s health information from unauthorized use while allowing patients to still receive the care that they need. Regardless of what area of health care you work in, you will use HIPAA. While dealing with patient information of any kind, you will be regulated by HIPAA on how to properly handle the information to ensure that it is kept private and safe.

What you will cover

1. Secure health care transactions and billing

a. Describe how electronic data interchange transactions work.

1) They are mandated by HIPAA

2) They standardize electronic transactions so that all information systems can send and receive the same electronic transactions

b. Describe the billing workflow.

1) Verifying insurance eligibility

2) Billing third party plans

3) Use of codes and patient registration

4) Claims

5) Payment and patient accounts

6) Coordination of benefit claims (COB)

7) Copays and EOB

c. Identify HIPAA privacy requirements.

1) A patient’s identification can only be shared with authorized health care providers

2) A patient’s identification and health information must be kept out of public view

3) Must receive patient’s consent when patient information must be shared with others

4) Annual HIPAA training and education

5) Mobile storage devices that pose a risk and management of data contained therein:

a) Thumb drives

b) Memory cards

c) Tablets and phones

6) Minimization of risks

a) Security Officer: A position within the health care organization that is required by HIPAA. Responsible for development, implementation, and adherence to these policies and procedures. Responsible for tracking and handling security breaches and incidents.

d. Discuss the relationship between EHR, reimbursement, HIPPA, and EDI transactions.

1) How has HIPAA changed how health care information is stored and accessed within the EHR?

2) How has HIPAA changed how information is transmitted through EDI?

3) Describe how EDI facilitates electronic transactions.

4) What are the effects of HIPAA on EDI?