Beaverlog Tips: Volume 11 - April 11, 2003

This issue of Beaverlog Tips is coming to you rather sooner than we had planned. No sooner had we releaser version 2.0.010 than we received reports of problems in previous versions plus one that was unique to 2.0.010. Despite this, we have an informative article to present.

HIPAA Compliance in The THERAPIST for Windows

HIPAA is an acronym for Health Insurance Portability and Accountability Act. This is a federal law that adds many diverse regulations related to the health industry. Three sections of this law affect practice management software and The THERAPIST for Windows complies with both.

Privacy

HIPAA includes hundreds of pages describing how patient health information must be handled in order to insure the patient’s privacy. These include requiring that computer software that stores or displays patient health data must be able to restrict access to this information.
The THERAPIST for Windows offers login password protection plus the ability to restrict access to sensitive data to only selected users. This function is completely flexible, allowing the system administrator to define groups of users and restrict or grant access on a group-by-group basis.

 

Electronic Claim Format

HIPAA has standardized the format for electronic health care insurance claims. The full name of this standard for professional (not hospital inpatient) claims is ANSI X12 4010 837 X098. ANSI is an acronym for American National Standards Institute, the body that developed the standard. X12 is their designation for a broad class of electronic communication covering many different industries and businesses. 4010 is a version number of the standard and will evolve over time. 837 is the number designating health insurance claims and X098 indicates that it is for professional claims as opposed to hospital inpatient claims.

This format is requirement for all insurance payers and providers who submit claims directly to them. Claim clearinghouses must also use this format to transmit claims to the payers. However, a provision of the law allows the clearinghouse to accept claims from providers in any claim format the clearinghouse allows. It is then the responsibility of the clearinghouse to convert claims to the HIPAA standard.
The THERAPIST for Windows generates electronic claim files in the format specified by the HIPAA standard. It also generates claims in the simpler NSF 3.01 and HCFA-1500 print image formats.

 

Code Sets

HIPAA electronic claims use a variety of codes to convey patient, eligibility, condition, diagnosis, and treatment information from the provider to the payer. HIPAA has standardized these code sets so that a given code has the same meaning regardless of who is sending or receiving the information. Older claim formats used some of these codes but assigned different meanings to some of them.
The THERAPIST for Windows include the standard code sets as well as the older codes. The program provides for translating codes entered using the old system to HIPAA standard codes when ANSI X12 claims are generated.