| HIPAA FAQ
Q: How do I know if I’m covered by
HIPAA?
A: The Health Insurance Portability and Accountability Act
(HIPAA) applies only to health care providers who use electronic means—such as
Internet, extranet, virtual private network, and dial-up—to perform designated
transactions. Those include filing claims, determining eligibility, receiving
payment, checking claim status, and seeking referral authorization. It also
applies to those whose billing service or clearing-house engages in such
electronic transactions on their behalf.
Q: Am I covered by HIPAA if I e-mail information on
a patient to another doctor?
A: Merely transmitting health
information electronically does not subject you to HIPAA regulations. You must
engage in one of the designated transactions. However, you are still obligated
by state law to protect such information, and you must be sure your means of
transmission is reasonably safe.
Q: Can I opt out of HIPAA by not engaging in
electronic transactions?
A: Yes. If you choose not to engage in
electronic transactions and do not to use a billing service or clearinghouse
that does so, you will not be required to comply with HIPAA’s privacy and
security rules. Though this may save you some time and trouble in the short
term, it may also mean that the payment of your claims will be delayed until
well after all electronic claims are paid. CMA leaders believe that all
physician practices will benefit from the efficiency and savings of electronic
transactions. Read about these benefits in ON CALL document #1600 (available
free to members at http://www.cmanet.org/logon). Nonmembers can purchase the document at the CMA Bookstore for $66.
In a separate rule, Congress decided that practices with 10
or more FTEs (full time equivalents), including physicians, must file Medicare
claims electronically after October 16, 2003. Complying with this obligation
will subject you to HIPAA. This rule applies only to Medicare.
Q: Might the government eventually require all
physicians to file claims electronically?
A: It is possible that
health plans, not the government, will require participating providers to file
electronically. The only government requirement at present is the one for
Medicare discussed above.
Q: Does filing a compliance plan automatically mean
I have to comply with HIPAA?
A: According to the U.S. Department of
Health and Human Services, filing the compliance plan (due no later than October
15, 2002) will not subject you to HIPAA if your practice activities do not come
within the statute’s requirements. If you are now using electronic means or plan
to do so before October 2003, CMA recommends that you file the compliance plan
now to avoid any risk of Medicare exclusion for failure to comply with HIPAA’s
transaction rule.
Q: If I file the plan, do I get to delay compliance
with the privacy rule?
A: No. The privacy rule becomes effective
April 14, 2003 for all covered by HIPAA.
See http://www.calphys.org for
more HIPAA information.
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