HIPAA Analysis

Describe HIPAA, its purpose, and provisions.

HIPAA stands for Health Insurance Portability and Accountability Act. Passed in
1996, the Act has five titles that spell out its purpose and provisions. Title I. protects workers
and their families from losing their insurance coverage any time they lose or change their
jobs. It also prevents new healthcare plans from denying one coverage of their pre-existing
conditions (Edemekong et al., 2018). Title II. covers three areas. They are medical liability
reform, prevention of healthcare fraud, and administrative simplification. With regard to the
latter, HIPAA established electronic healthcare transaction standards (Edemekong et al.,
2018).

Title III. establishes rules for pre-tax medical spending accounts and makes changes
to medical insurance deductions. Title VI. establishes rules for group health plans while Title
V. provides guidelines on treating non-U.S. citizens and life insurance policies that are
company owned (Edemekong et al., 2018). Thus, HIPAA serves numerous purposes.
However, the main one is strengthening confidentiality in the country’s health care system
and prevent workers from losing their health insurance when they change or lose their jobs.

What are the HIPAA requirements for electronic claims?

One of the goals of HIPAA is to simplify and increase administrative efficiency while
at the same time maintaining privacy of data of patients. To this end, HIPAA establishes
standards for electronic medical transactions that apply in the whole country. HIPAA’s Title
II. requires that all healthcare providers that are covered under the Act submit all of their
claims electronically and use a format that is approved by the Act. The format that HIPAA

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provides for electronic submission of claims is called ASC X12 005010 (Medical Billing &
Coding, n.a). It is more commonly referred to as HIPAA 5010. Under HIPAA 5010, each
transaction type has a code that billers are supposed to follow when submitting claims.

What are the social, legal, and ethical ramifications of HIPAA violations? Provide an
example of each.

HIPAA violations occur when a person acquires, uses, or discloses protected health
information in a manner that leads to personal risk of the patient. HIPAA violations attract
penalties whose magnitude depends on the extent of the violations. The penalties can either
be civil or criminal. Violating HIPAA regulations without malicious intent attracts civil
penalties. For instance, if a person unknowingly violates HIPAA regulations, they are fined
$100 (Edemekong et al., 2018). HIPAA violations that are considered criminal are those that
involve individuals who make the violations with a malicious intent. Such violations attract
heavier fines. For instance, HIPAA violations committed for personal gain attract a penalty of
$250,000 or a jail term of up to ten years (Edemekong et al., 2018). Social and ethical
consequences of violating HIPAA include ostracization by colleagues, loss of employment,
and loss of medical license, thus preventing one from practicing.

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References

Edemekong, P. F., Annamaraju, P., & Haydel, M. J. (2018). Health Insurance Portability and
Accountability Act.

Medical Billing & Coding (n.a). HIPAA and Billing.
https://www.medicalbillingandcoding.org/hipaa-billing/