CMA Clarifies HIPAA Misconceptions

The Tucson, Arizona-based Association of American Physicians and Surgeons (AAPS) recently wrote its members (some of whom are CMA members) to encourage them to "take the country doctor route" to escape the Health Insurance Portability and Accountability Act (HIPAA) security and transaction confidentiality rules. The letter contained several statements that are misconceptions and warrant clarification.

An amendment to the HIPAA law does require all Medicare claims to be submitted electronically, but all medical practices with nine or fewer full-time-equivalent staff are automatically exempt from this rule. (AAPS indicated the exemption was discretionary.)

The AAPS letter also implied that any violation of HIPAA, even an unintentional one, could bring a jail sentence. In fact, as CMA’s HIPAA experts stress, only people intent on violating HIPAA’s confidentiality requirements or who seek to profit by doing so risk incarceration.

AAPS provided its members a "Model Patient Privacy Protection Advisory" to distribute to patients informing them of their physician’s decision to "remain a noncovered entity" under HIPAA. CMA urges you not to distribute this advisory to your patients, as it contains many inaccuracies. One of those inaccuracies is that there is a national computer database into which all patients’ records will be put if their health care providers are covered by HIPAA. This is simply false—there is no such database. The advisory also states that if a physician doesn’t submit any transactions electronically, HIPAA does not apply. This, too, is inaccurate, because should a clearinghouse or billing service transmit claims electronically on your behalf, you must comply with HIPAA.

AAPS exhorts physicians to do everything possible to avoid HIPAA. CMA, however, believes that small and solo practices in particular can benefit tremendously from HIPAA’s transaction rule. This rule, which simplifies and standardizes health care transactions and code sets, will both lower physicians’ administrative costs and reduce the number of lost claims.

For more information on HIPAA, visit http://www.calphys.org. There you will find the latest HIPAA news and links to CMA’s exclusive products and resources to help physicians make their practices HIPAA compliant.

Information: CMA’s legal information specialists 415/882-5144 or legalinfo@cmanet.org .