HIPAA brings new requirements, new opportunities

Area of Science:

• Healthcare Administration
• Health Informatics
• Health Policy

Background:

• The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandated federal regulations for healthcare simplification and cost reduction.
• The Department of Health and Human Services (HHS) has been developing proposed rules to implement various aspects of HIPAA.

Purpose of the Study:

• To outline the federal rules established under HIPAA for the electronic transmission, privacy, and standardization of health information.
• To inform healthcare providers about the opportunities presented by HIPAA standards for improving efficiency and reducing administrative costs.

Main Methods:

• Review of proposed federal rules published by HHS related to HIPAA implementation.
• Analysis of the implications of HIPAA standards on healthcare administrative processes and electronic commerce.

Main Results:

• HHS has published proposed rules covering security, privacy, transactions, code sets, and national identifiers.
• Additional proposed rules concerning claims attachments and health plan identifiers are forthcoming.
• HIPAA standards, while not mandating electronic business, provide a framework for significant administrative cost reduction.

Conclusions:

• The implementation of HIPAA necessitates new federal rules to achieve simplification and cost reduction in healthcare.
• Healthcare providers can leverage HIPAA's electronic commerce standards to enhance efficiency and decrease administrative expenses.