HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) does a few things for people, organizations and the government. It introduces terminology we want to understand so let's do a brief overview.

Value Of HIPAA To People

When people move to a new health insurer, pre-existing conditions are no longer excluded from health insurance coverage.
You have a right to access your medical records in the possession of a health insurance provider.
You can open a 'medical savings account' as a result of HIPAA legislation.
Your healthcare records and medical conditions are no longer a matter of public record, they are now kept private, under a rather strong penalty for exposing your records to others - intentionally or by breach of security.

Protected Data And De-Identified Data

Your protected healthcare data has a term - Protected Health Information (PHI). If there is protected healthcare information, that implies there is un-protected healthcare information.

What they do is is strip away data that identifies you as an individual. This 'de-identified' data is fair game and used extensively for statistical analysis. Health insurance companies and the government use this 'de-identified' data regularly - and they do data analysis down to a postal code to identify risk. That's definitely a benefit to the insurers. It's also of benefit to the government, allowing them to more accurately identify 'hot-spots' of diseases across the United States.

Medical Billing

HIPAA mandates streamlining and standardizing medical billing across the United States. They mandate a common method of communicating stored electronic healthcare records, security and a whole bunch of other stuff. The HIPAA legislation created a cottage industry specializing in how to stay in compliance and a discussion is far beyond the scope of MediSeek Recaster.

Diagnosis Codes

Diagnosis Codes identify the reason someone went to a healthcare provider. They did not originate with HIPAA, but go all the way back to the 1500's when they were calls 'Bills of Mortality'. Back then, they recorded burials, not deaths. Over the centuries this recording system has morphed into the International Code of Diseases - Version 10 (ICD-10), with over 150,000 diagnosis codes and procedure codes. Ouch, that seems like a lot of codes.

Taxonomy Codes

Taxonomy Codes do originate from the HIPAA legislation. Taxonomy Codes identify the area of specialty of a healthcare provider. We have found no correlation between a Taxonomy Code and a Diagnosis Code.

Taxonomy Codes are an important topic and get their own discussion, here.

The National Provider Identifier

Mandated by HIPAA The ID for healthcare providers is called the National Provider Identifier (NPI). An NPI is a 10 character long numeral and there is quite a bit of information stored about an NPI which is important.

All information about an NPI is disseminated and
made public as a result of HIPAA.
MediSeek Recaster is about getting this disseminated
NPI data into your database servers.

The Centers for Medicare and Medicaid (CMS) is tasked with maintaining and administrating NPI's. To make this happen involves ...

Collecting information from healthcare providers,
A database to store this information and,
A way to disseminate this collected information, which we discuss here.

States still issue licenses but the NPI works at a national level to identify a provider. Healthcare providers that bill for products and services are required to have an NPI, other healthcare providers who do not bill may not have an NPI.

The HIPAA Legislation

An initial big drawback to the HIPAA legislation when it was signed into law - was the up-front expense to meet the requirements. With all the new billing requirements and other rules and regulations, many physicians could no longer operate independently. This is one reason you hardly ever see independent physicians, they are now all affiliated in some manner.

The government did not and does not offer software to help meet the requirements. Large organizations had teams of programmers and did not offer this software as a service.

Some aspects of HIPAA have yet to be automated and made more available to consumers and healthcare providers alike, and this is where MediSeek steps in - we offer to consumers and to organizations the healthcare provider data that HIPAA requires to be published, combined with the Taxonomy Codes.