How HIPAA Imposes on the Claim Process

Congress passed the Health Insurance Portability and Accountability Act in 1996 out of concern for the privacy and confidentiality of patient health care information. HIPAA affects covered entities, such as insurance plans and third-party billers, that have access to patient medical information.

Function

• After doctors treat patients, claims are submitted to the patients' health plans so that the doctors can be reimbursed for their work. A claim contains a patient's name, diagnosis and other medical information that is protected under the HIPAA privacy rule. Those who handle medical claims must take care to keep the patient's information private and secure.

Effects

• Claims employees have access to a lot of patient information, so they must learn about HIPAA to ensure they handle patient information properly. For instance, claims workers must never discuss patients, or patient information, with others outside of work. Additionally, it is a violation of the HIPAA security rule to leave an electronic claim open on an unlocked computer. All computers must be password-protected and locked whenever an employee leaves his work station.

Significance

• Violating HIPAA rules is a punishable offense that may result in fines, jail time or both, depending on the severity of the offense. Claims offices must construct HIPAA policies to ensure claims workers are familiar with the significance of HIPAA and do not accidentally violate it. HIPAA training must also be provided to claims workers to remind them of the rules and inform them of any updates to the law.