March 2003
In search of HIPAA
by Dr. Jeffrey Shay
The issue that has generated more phone
calls and letters to chiropractic groups this winter has been HIPAA.
Doctors are not giving opinions or taking sides on this issue, so much as
they are confused and frustrated by what the rules are supposed to mean,
as well as to whom they apply.
I have heard many conflicting opinions
from doctors. Worse, articles are appearing in chiropractic magazines also
full of contradictions. I've even talked with several doctors who have
attended HIPAA seminars sponsored by various organizations whose findings
are at odds with each other. After perusing several publications, I feel
that I'm finally able to make some sense out of this business, and I will
try to clarify some of the requirements in this month's column.
I'm going to use two sources that are
available to chiropractors. While they don't agree in every aspect, where
they don't I'll try to explain the reasons for the differences.
The first source is a CD on HIPAA made
available by Life Chiropractic College West dealing exclusively with HIPAA
law and standards from a chiropractic standpoint. The second source is a
web page entitled DC-HIPAA.com, which appears to be operated by NCMIC
Chiropractic Solutions, the malpractice insurer.
Question 1: What is HIPAA?
HIPAA is an omnibus privacy act passed
by Congress for the purpose of protecting consumer privacy, setting
standards and providing penalties for non-compliance. In plain English,
the government is requiring you to protect the privacy of your patients,
which includes record storage retention and transfer, claims filing, and
other office procedures. All offices covered under the law must be HIPAA
compliant by
April 14, 2003
.
Question 2: Who is affected by HIPAA?
How does this law affect my practice?
This is the most asked question of all,
and probably the least understood. The confusion lies in the obscure
language in the law and the necessity for interpretation.
Both sources listed here agree that
HIPAA applies to doctors or clinics that have more than ten employees
and/or file insurance claims electronically. However, this is where the
disagreement begins.
While the DC-HIPAA web page feels that
small practices that do not file electronically may be exempt, Life West
expands the definition of practices that are required to meet HIPAA
standards.
In the first place, the law is
nebulous, and talks about file transfer in general instead of electronics
claims filing per se. The expanded definition of electronic filing could
then mean any type of file transfer, and not just claims filing. This
would include use of an electronic recordkeeping system, even using a
floppy disc or CD-ROM to move a file or to save a record. Even the
definition of "patient records," when expanded, may include
keeping any type of record or list pertaining to patients, thereby
requiring doctors to meet HIPAA standards.
One more thing. Life West points out
that the law as passed has open language suggesting that a broader
interpretation may be used in the future, forcing almost every doctor into
the system.
Question 3: Can I still have sign-up
sheets in my office?
Yes, as long as they are generic. For
example, having patients sign a sheet simply acknowledging their presence
is OK. Having a special sign-up list for sciatica would not be (although I
do not know why you would have such a thing).
Question 4: What must be done to
comply?
This part requires a number of actions,
too many to list in this article. I will enumerate a few, but both sources
go much further into remedies and paperwork that may be required.
a.If you file claims electronically,
you must use software that meets HIPAA requirements; also, your jobber or
intermediary needs to meet standards, as well as the insurance company on
the receiving end.
b.You need to be prudent in the storage
and transfer of patient records, as well as affording the patient to have
access to his/her records.
c.You must have a privacy control
officer in your office.
d.You must have forms available for
patient signature detailing your compliance with privacy requirements and
records handling.
I
realize that HIPAA and related government initiatives take all of the fun
out of practicing chiropractic. The lengthy recordkeeping already required
by most insurance companies and Medicare seems to have little purpose
other than to rain on your parade. That's the nature of life anymore.
There's always someone to mess up a good thing.
When
I was a kid, my brother and I used to go to the movies with our friends.
Things were great until my parents made us take our little sister along
for the Saturday matinee. For a 10 year-old, the only thing worse than
being seen in public with your sister would be having word get out that
your pajamas have feet in them.
We
made a new set of rules. She had to sit no less than five rows away from
us and was not allowed to act like she knew our names. For this, we bribed
her with enough money for Milk Duds and popcorn, depositing her down front
with the crowd lacking permanent teeth. It was our way of getting around
the system.
So,
I guess I can be a privacy officer. Since we have a small clinic, I can
just add it to my list of accomplishments, like head landscaper, computer
operator and restroom generalissimo.
So
who do you believe, DC-HIPAA or Life West? Both claim to have done the
appropriate research on HIPAA. Personally, I believe that DC-HIPAA may be
correct at present, but the penalties for non-compliance are onerous. In
the long run, Life West's version is probably right. I believe the intent
is for the government to apply the standard to all of us eventually. You
can check out DC-HIPAA.com on the Internet.
I
recommend that you buy the CD from Life West by calling the college
bookstore; it seems to be the best insurance against problems with HIPAA.
The cost is $50.00, and you can use a credit card that you haven't already
maxed out.
If
you think that government will only audit the guilty, runs a tax system
oozing with fairness, and that there was no one with a rifle on the grassy
knoll, DC-HIPAA is for you.
Otherwise,
you'd better be California Dreamin'.
How
you handle the Milk Duds is your business.
-----
Note:
After writing this column for The Chiropractic Journal, I had a
chance to visit with Dr. Gerald Clum, President of Life Chiropractic
College West, about HIPAA. He was very helpful, and especially emphasized
the difference between filing responsibilities and patient rights. It
would be beneficial for doctors to attend one of the seminars on this
subject. I would recommend one of Life West's courses if available in your
area. Note that the CD I mentioned is an auxiliary to Life's lectures.
(Dr.
Jeffrey Shay, a graduate of
Palmer
College
of Chiropractic and the WCA's 1996 "Chiropractor of the Year,"
is the World Chiropractic Alliance Director of Insurance Relations. He
welcomes comments or questions regarding any insurance-related subject
appearing in this column. Dr. Shay is available to speak to your state or
local organization. Contact him at
1300 Cedar St.
,
Muscatine
,
IA
52761
,
or the WCA offices, FAX 480/732-9313.)
