AHA writes letter, HHS proposes HIPAA changes
Rule changes correct unintended consequences
Hospitals often are frustrated by the frequent delay of Medicare payments, and now payers have indicated that payments will not be faster or smoother as a result of standardization under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), according to a May 2, 2002, letter written to Tommy G. Thompson, secretary
of the Department of Health and Human Services.
There’s a growing concern among health care providers that payments by both private and government payers will be further delayed because of ambiguity in how HIPAA is being interpreted.
"Although Medicare regulations and many state laws have been implemented to try to ensure the prompt payment of claims, these prompt-pay rules are often violated or otherwise ignored, particularly by private payers," writes Rick Pollack, executive vice president of the American Hospital Association (AHA) of Chicago.
"The regulation clearly states that health plans are not permitted to require additional data elements nor standard date elements in a format different from that specified in the standards," Pollack says.
"In guidance or regulation, HHS should clarify that health plans must accept a HIPAA-compliant claim as a clean claim’ for purposes of contractual provisions with other covered entities under HIPAA, and for state and federal prompt pay requirements," Pollack writes.
Meanwhile, HHS has proposed changes to HIPAA’s health privacy regulations to correct some unintended consequences that have threatened patients’ access to quality health care.
These proposed changes include the following:
• Strengthen notice provisions and remove consent requirements hindering access to care.
HIPAA wasn’t intended to interfere with patients’ access to health care in such a way as to, for example, require a patient to visit a pharmacy in person to sign paperwork before a pharmacist can fill the patient’s prescription order, HHS explains in a notice published Mar. 21, 2002.
Nor was HIPAA intended to erect similar barriers to specialist referrals.
HHS has proposed to fix these unintended consequences by removing consent requirements for treatment, payment, and health care operations that could interfere with efficient delivery of rights and practices.
No penalties for incidental disclosures
• Maintain the "minimum necessary" rule, while allowing treatment-related conversations.
Medical providers and clinicians had expressed concern that even oral communications between doctors, nurses, and others involved with a patient’s care could violate the privacy rule.
HHS proposes a change that makes it clear that doctors could discuss a patient’s treatment with other doctors and professionals involved with that patient’s care without fear that their conversations are in violation of HIPAA.
"As long as a covered entity met the minimum necessary standards and took reasonable safeguards to protect personal health information, incidental disclosures — such as another patient hearing a snippet of conversation — would not be subject to penalties," HHS states.
• Assure appropriate parental access to their children’s records. HHS proposes a clarification to HIPAA that acknowledges that state laws govern disclosures to parents, and where state law
is silent or unclear, the revisions would permit a health care provider to use discretion to provide or deny a parent access to such records.
• Prohibit use of records for marketing, while allowing appropriate communications.
HHS proposes to explicitly require pharmacies, health plans, and other covered entities to first obtain an individual’s specific authorization before sending them any marketing materials.
• Assure privacy, without impeding research.
This proposal would eliminate the need for researchers to use multiple consent forms. One informed consent form could accomplish both purposes of ensuring privacy and informed consent about the research procedure.
• Provide model business associate provisions.
Rehab facilities, hospitals, and other providers had been concerned that the privacy rule would impose a cumbersome burden by requiring them to make sure that their business associates follow the privacy rule’s requirements.
HHS proposes they can make this process easier with model business associate contract provisions, and it would give covered entities up to an additional year to change existing contracts, easing the burden of renegotiating contracts all at once.
• Simplify authorizations.
HHS proposes allowing the use of a single type of authorization form to obtain a patient’s permission for a specific use or disclosure that otherwise would not be permitted under the rule.
"Patients would still need to grant permission in advance for each type use or disclosure, but the proposal would eliminate the need to use different types of forms to obtain that advance permission," HHS states.
For more information on HIPAA, go to the HHS web site: www.hhs.gov/ocr/hipaa.
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