NOTE: The World Chiropractic Alliance is preparing a selection of forms and notices that will help you comply with these regulations. They will be published in The Chiropractic Journal and/or made available on the WCA web site for free downloading.

In the October issue of The Chiropractic Journal, I reviewed the contents and implications of the new "Privacy Rule" (more formally known as the HIPAA "Standards of Privacy for Individually Identifiable Health Information")

In this follow-up, I planned to discuss the frequently asked questions about the rules, but almost all the inquiries I've received are merely versions of the same question: "Does this rule apply to me?" Therefore, I'll address that issue in more detail.

In short, you are a "covered health care provider," subject to the new privacy regulations, if all of the following are true:

(1) As a chiropractor, you furnish, bill or receive payment for health care in the normal course of business. ("Health care" is defined as "Care, services, or supplies related to the health of an individual.)

(2) You conduct covered transactions. "Covered transactions," in the words of the regulations, include the following:

*** A request to obtain payment, and necessary accompanying information, from a health care provider to a health plan, for health care... If there is no direct claim, because the reimbursement contract is based on a mechanism other than charges or reimbursement for specific services, the transaction is the transmission of encounter information for the purpose of reposting health care.

*** An inquiry from a health care provider to a health plan, or from one health plan to another health plan, to obtain any of the following information about a benefit plan for an enrollee... Eligibility to receive health care under the health plan... Coverage of health care under the health plan... Benefits associated with the health plan... A response from a health plan to a health care provider's (or another health plan's) inquiry described in" the foregoing.

*** A request for the review of health care to obtain an authorization for the health care... A request to obtain authorization for referring an individual to another health care provider... A response to a request described in" the foregoing.

*** An inquiry to determine the status of a health care claim... A response about the status of a health care claim."

*** The transmission of subscriber enrollment information to a health plan to establish or terminate insurance coverage."

*** The transmission of any of the following from a health plan to a health care provider's financial institution... Payment... Information about the transfer of funds... Payment processing information" and "The transmission of either of the following from a health plan to a health care provider... Explanation of benefits... Remittance advice."

*** The transmission of any of the following from the entity that is arranging for the provision of health care or is providing health care coverage payments for an individual to a health plan... Payment... Information about the transfer of funds... Detailed remittance information about individuals for whom premiums are being paid... Payment processing information to transmit health care premium payments including any of the following... Payroll deductions... Other group premium payments... Associated group premium payment information."

*** The transmission from any entity to a health plan for the purpose of determining the relative payment responsibilities of the health plan, of either of the following for health care... Claims... Payment information."

(3) You transmit any of the covered transactions in electronic form. That means using "electronic media," including "transmissions over the Internet (wide-open), Extranet (using Internet technology to link a business with information only accessible to collaborating parties), leased lines, dial- up lines, and private networks, and those transmissions that are physically moved from one location to another using magnetic tape, disk, or CD media."

According to the government web site, "If a health-care provider uses another entity (such as a clearinghouse) to conduct covered transactions in electronic form on its behalf, the health-care provider is considered to be conducting the transaction in electronic form."

Additional FAQs are answered at http://www.hhs.gov/ocr/faqs1001.doc.

Did you answer "Yes" to the first two questions but "No" to the third? Don't breathe a sigh of relief too soon. There's another statute called the HIPAA Administrative Simplification Compliance Act (beware of any law called "Simplification"). According to the official web site, "ASCA prohibits HHS from paying Medicare claims that are not submitted electronically after October 16, 2003, unless the Secretary grants a waiver from this requirement. It further provides that the Secretary must grant such a waiver if there is no method available for the submission of claims in electronic form or if the entity submitting the claim is a small provider of services or supplies. Beneficiaries will also be able to continue to file paper claims if they need to file a claim on their own behalf. The Secretary may grant such a waiver in other circumstances."

Space considerations do not allow a discussion here of the definition of a "small provider," but the answer may be found at http://questions.cms.hhs.gov/cgi- bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=1183.