HIPAA regulations
govern health care transactions and data exchange.
The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 and is enforced in Texas. The purpose of the statute is to help consumers maintain insurance coverage; however, it has other goals as well that focus on efficiency within the health care system.
Privacy
Many of HIPAA's regulations focus on privacy and protecting an individual's health information. Prior to purchasing any type of prescription medication, consumers are required by law to have been informed at least once of the HIPAA rights to privacy regarding the security of the technology and payment process.
Security
HIPAA regulations pertain directly to electronic protected health information---or PHI. These pertain to the majority of health plans and the regulations focus on security in several categories.
The first category is considered administrative safeguards, which focus on procedures, policies and practices, including information access and sanctions for the entity's workforce. Physical safeguards focus on minimizing access to information within buildings, offices, departments and desks through means of locks, access badges and well-hidden workstations. Technical safeguards prevent information from being accessed by specific groups of people and tracking access.
EDI
HIPAA sets into place the EDI---or electronic data interchange---which serves to create regulations governing transactions for monitoring, access, and data-storing. EDI sets into place several codes that can be used during the transaction or exchange of information. The main purpose is to ensure that the electronic information exchanged during a transaction is standardized to increase time efficiency and avoid confusion.
NPI
Another HIPAA aspect is national provider identifiers (NPIs) which serve as identifiers for health care providers. This is done to make the administrative processes in health care run more smoothly, improving referrals, billing and data accuracy.
Penalties
Any non-compliance with HIPAA laws carries strict and harsh penalties. The Office of Civil Rights is allowed to enforce penalties up to $25,000 per violation per calendar year. The U.S. Department of Justice is also allowed to enforce penalties of up to 10 years imprisonment and a $250,000 fine for non-compliance.
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