Defining The APMA's Position On HIPAA
- Volume 15 - Issue 7 - July 2002
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I read with great interest your recent editorial regarding HIPAA (see “Ready Or Not, Here Comes HIPAA,” page 14, April issue). As Vice-President of the APMA and Chair of the Health Policy Committee, I have direct oversight of these activities. We fully agree with the need for education regarding HIPAA and implementation of the final guidelines.
The APMA is producing a HIPAA Compliance Manual that will be free to APMA members. However, after the March release of revisions to the proposed rule and final standards, we decided to delay production of the manual until 60 days after the final rule is published. This publication deadline is Oct. 14, 2002, but might occur sooner.
We caution against using any manual produced prior to the release of a final rule since many of the existing policies will change as a result of the proposed regulations. Directives and policies have changed and will no doubt change again in the final rule. We strongly encourage all APMA members to use our manual when it is produced, and encourage all other DPMs to access the best information available.
With regard to the transaction standards, which have a deadline of Oct. 16, 2002, we advise all DPMs to apply for an extension of one year. The form is available at the APMA Web site (www.apma.org) or at the CMS Web site (www.cms.hhs.gov/hipaa.hipaa2/ascaform.asp) as well. Simply put, vendors of all sorts will not be ready to implement these standards and, thus, all providers will need to file for a delay.
The APMA manual alone is a significant member benefit that enhances the valuable resources available to all APMA members.
Thanks for your continued interest in podiatry.
-Lloyd S. Smith, DPM
Chair, Health Policy Committee
More Thoughts About HIPAA
The news article, “Changes In The Wind For HIPAA,” in the March issue of Podiatry Today was a good reminder to all physicians. However, HIPPA goes further than merely mandating the electronic submission of medical claim forms.
As a covered entity under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, it mandates the electronic connectivity, transmission, storage/retrieval and confidentiality of medical records and related healthcare information (including claims). Its goal is to reduce the 17 percent administrative cost of healthcare through the standardization of electronic transactions into a single format, rather than the more than 400 disparate platforms in use today.
For purposes of the act, the definition of a covered entity, includes the following three classes:
1. Individual healthcare providers (DPMs, MDs, DOs, DDSs, PhDs, CRNAs, etc.) pharmacies, hospitals, skilled nursing facilities (SNFs) and home healthcare agencies.
2. Medicare, Medicaid, insurance companies, HMOs, MCOs and other health plans.
3. Healthcare vendors, clearinghouses, billing firms, Internet service providers (ISPs), Web servers and hosting companies, as well as computer software and hardware companies, or other third-party vendors facilitating the electronic data interchange (EDI).
The full cost of implementation is unknown, but it is expected to increase the overhead costs of covered entities, significantly. In fact, HIPAA just may be the 800-pound gorilla that drives inefficient and marginal doctors out of business, while reaping financial rewards for technology and e-commerce firms.
Also, the act requires all related vendors to be HIPAA-compliant within 24 to 36 months of the effective date. Civil penalties may reach up to $100 per violation, with a $25,000 per year cap. Criminal penalties include fines reaching $ 250,000 and/or imprisonment for up to 10 years.
Of course, confusion is sure to be a hallmark of HIPAA regulations. So all readers are invited to visit our Web site (http://www.MedicalBusinessAdvisors.com) for additional information on this and related economic topics.
-David Edward Marcinko, MBA
Medical Business Advisors, Inc.