When the HIPAA Privacy regulations went into effect last year, Americans were offered several rights as health plan members. One of those rights includes establishing a confidential communication. This enables you to request that all correspondence from your health plan and providers go to a designated address — not the address on your account.
A confidential address is designed to be used only when communicating with you at your primary address could lead to personal harm. It is not to be used simply because you don't want someone at home seeing your mail or due to a separation from a spouse. A confidential communication should only be used for its intended purpose — to help keep you safe.
Health plan members accidentally make confidential communications requests for incorrect reasons. The author wants to reiterate that a confidential communication should only be requested if you feel that your life would be in danger if medical correspondence went to your primary address.
To establish a confidential communication, please contact your health plan. They will assist you with the process.
To Opt In Or Out
No one wants to be a patient in a hospital. Unfortunately, sometimes forces require a hospital stay — whether overnight or long-term. As part of the HIPAA Privacy regulations, you have the right to determine if you want anyone knowing that you are in the hospital.
When you are admitted, you have an opportunity to determine if you want to opt in or out of the hospital directory. When some people hear about this, they quickly choose to not be included in the directory. They attempt to protect their privacy or incorrectly feel that inclusion in a directory could lead to follow-up calls, marketing, or other troublesome situations.
That is actually not the purpose of a hospital directory. The directory is intended to inform visitors that someone is a patient and their room number. In most circumstances, it may be the only way to track someone down.
As a result, there are problems associated with opting out of the directory. If you elect to not be listed, then no one will know you are there. That includes spouse, children, parents, friends, religious leaders, etc.
For example, if your son visited the hospital and asked for your room number, the hospital could not release it to him. The hospital also could not confirm that you were staying in the hospital. That means that your son could not find you unless you contacted him and provided the room number. There is a chance you may not realize it for a while and wonder why no one is visiting you — especially your family.
Some people provide a list of select people that may receive information. That works for most, but don't forget to include someone important or else they will be blocked.
The author's advice is to think carefully before deciding whether or not to fully opt out of the hospital directory. It may cause more headaches for you and your family than you intended.
You Mean HIPAA Is More Than Privacy?
Many Americans believe that the HIPAA regulations are just about Privacy. That is actually not true. In the last issue of HIPAA Blues, it was mentioned that there are four components to HIPAA: Privacy, Transactions and Code Sets, Security, and National Identifiers. Most of the emphasis in the media, community and at your doctor's office is on Privacy because it has the most impact on your life. So, it's not surprising that many think that HIPAA meant Privacy.
To help you better understand HIPAA, this article focuses on Transactions and Code Sets. What is it? What does it do? How does it help?
Simply put, Transactions and Code Sets are an electronic and faster way for health plans and providers to process health information. Instead of mailing forms or calling the health plan, information can be processed through a few strokes of the keyboard. It is more efficient and much faster. Doctors get paid faster. The office staff can expedite the approval of an authorization or referral quicker. It also provides a more effective way to let doctors know if they are still your primary care physician. And, all of this is done via your computer through a process called Electronic Data Interchange.
There are several individual components within Transactions and Code Sets, each designed to handle a different segment of medical administrative responsibilities. The following table provides a listing of what they are and their purpose.
TRANSACTIONS & CODE SETS
| Name | Purpose |
|---|---|
| Enrollment / Disenrollment | Notifies the health plan and/or provider when a member has joined/left the plan or changed providers |
| Eligibility Inquiry | Verifies that a member is permitted to receive certain health benefits |
| Health Care Claim | Requests payment from a health plan after seeing the member |
| Payment And Remittance Advice | Payment And Remittance Advice |
| Payment Order Remittance Advice | Enables premium remitters to report premium payment information |
| Claim Status | Allows providers to check on the processing status of a particular claim |
| Referral Certification And Authorization | Processes approvals for member referrals and medical care authorizations |
The Transactions and Code Sets regulations went into effect October, 2002. However, due to extensions and contingency plan agreements, the health care community is still implementing most of the above-mentioned Transactions. When they are all in place, health plans and payors will find that certain administrative and medical activities are done more swiftly, accurately and efficiently. In time, Transactions and Code Sets will, hopefully, help to improve the quality of health care.