Destroy Medical Records Securely

When medical records are eligible for destruction, they can be shredded or burned.

Follow these guidelines for secure records destruction

What Can I Do About My BlueCompare/BlueChoice Solutions Ratings?

Texas Medical Association physician leaders and staff have worked for the past two years to win concessions from Blue Cross and Blue Shield of Texas (BCBSTX) to make its physician-rating program fair to doctors and useful to patients. Find out what you can do to contest and improve your ratings.

HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT OF 1996 (HIPAA)

The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for implementing various unrelated provisions of the Health Insurance Portability & Accountability Act of 1996 (HIPAA). Congress passed this law to provide consumers with greater access to health care insurance, to protect the privacy of health care data, and to promote more standardization and efficiency in the health care industry.

The Portability part of HIPAA includes patient protections for coverage under group health plans that limit exclusions for pre-existing conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also give the patient a right to purchase individual coverage if no group health plan coverage is available, and COBRA or other continuation coverage has been exhausted.

HIPAA ADMINISTRATIVE SIMPLIFICATION PROVISIONS

The Administrative Simplification provisions of HIPAA were designed to streamline the administration of health care. The various provisions include requirements for Privacy, Electronic Transactions and Code Sets, Security, and National (Unique) Provider Identifiers. These provisions apply to all covered entities.

NPI - NATIONAL PROVIDER IDENTIFIER

The National Provider Identifier (NPI) is a standard unique health identifier for health care providers. The Administrative Simplification provisions of the Health Insurance Portability & Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers, as well as for health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. All physicians will have to move to the NPI number to file claims for Medicare, Medicaid and commercial insurance. Once enumerated, a physician's NPI will not change.

NPI NATIONAL REGISTRY (Look Up)

For a link to the national registry to look up NPI numbers by individual or organization, click here.

APPLYING FOR YOUR NPI:

"The Who, What, When, Why & How of NPI: Info for Health Care Providers"   - from CMS (NOTE: This info advises when an individual may also need to complete the Type 2 application as well as Type 1.)

NPI Resource Sheet  from CMS - Jan 2007

NPI Frequently Asked Questions  from CMS

NPI Fact Sheet  from CMS - Jan 2006

NPI Fact Sheet for Healthcare Providers Who Are Individuals  from CMS - Jan 2006

For an overview of the NPI and other info  from CMS

To apply for your NPI number(s)

USING YOUR NPI:

Important information about enumeration errors, reporting other provider ID #s, billing, etc.:
MLN Matters Number #SE0725

TMA - NPI Resource Center

For help with implementing the NPI, the Texas Medical Association has developed the NPI Resource Center.

TrailBlazer Health - How to bill Medicare

At this time, TrailBlazer Health, the Texas Medicare Part B carrier, is requiring both the NPI and the UPI numbers on all claims filed. For more info, please see TrailBlazer Health's notice #11517. For claims filing instructions, see: How to Use Your NPI When Billing Medicare (notice #11917 - June 12, 2007)
Also, From TrailBlazer Health: NPI - Will You Be Ready? (notice #11820 - March 30, 2007)
(For more about NPI and Medicare, please note the "Addt'l info from the Texas Medical Association" above concerning Medicare claim rejections and re-enrollment.)
If billing with the CMS-1500 claim form, please also refer to the information below.

Revised 1500 Claim Form

The National Uniform Claim Committee (www.NUCC.org) has released the revised version of the 1500 Health Insurance Claim Form (version 08/05) that accommodates the reporting of the NPI. This refers to paper claims only. Electronic claims are under federal HIPAA 837 language.

The NUCC Web site provides a helpful 55-page instruction manual with detailed descriptions of each item number on the claim form . Changes/clarifications to the instruction manual also are posted on this site.

And the Texas Department of Insurance (TDI) has updated the "submission of clean claims" information to correspond with the revised claim form. See Commisioner's Bulletin #B-0030-07 (of July 17, 2007) and the amendments to sections 21.2802 and 21.2803 (pdf).

CMS (Medicare) has published a Special Edition MLN Matters article that contains important information on the NPI and claim submission. Please refer to SE0725. Also, see SE0729 for addt'l info about the testing and implementation phase.

NPI CONTINGENCY PLAN

The Centers for Medicare & Medicaid Services (CMS) has said it will not take action against physicians and other covered entities that do not meet the May 23, 2007 deadline to comply with the NPI regulations as long as they are sincerely trying to comply; however,...

Guidance on Compliance with the NPI Rule  (pdf) from CMS

Health Plans' Contingency Plans

For information about the various health plans' NPI contingency arrangements, click on the links below:

TEXAS MEDICAL ASSOCIATION - HIPAA RESOURCE CENTER

The Texas Medical Association (TMA) HIPAA resource center is an excellent source of practical guidance for the physician's office. Answers to questions of how to administer the various rules regarding privacy, electronic standards, security and the national provider identifier can be found here.

The Texas Medical Association (TMA) is . Answers to questions of how to administer the various rules regarding privacy, electronic standards, security and the national provider identifier can be found here.

e-Tips from TMA:
Three HIPAA Rumors Dispelled

TMA has prepared sample privacy notices in English and Spanish for patients of primary care physicians and specialists. They are available to you in PDF or Word formats. Simply download these documents and customize them for your practice.

TMA also has prepared a HIPAA-compliant Policy and Procedure Manual that covers everything from privacy policies to financial operations. You'll receive both a hardcopy and a CD-ROM with over 150 policies, including sample forms and letters that are customizable to your office. Call (800) 880-7955 or (512) 370-1550 to order or click here to view a complete table of contents. The cost of the manual is $250, with special discounts for those who have purchased the previous edition of TMA's policy and procedure manual.

TMA Practice Consulting also can assist you with HIPAA compliance and implementation in your office.

MEDICARE CLAIMS - HIPAA INFORMATION

Trailblazer Health Enterprises, the contracted Medicare intermediary/carrier in Texas, provides HIPAA updates and assistance with your Medicare claims.

MEDICAID CLAIMS - HIPAA INFORMATION

For HIPAA assistance with your Medicaid claims, the Texas Health & Human Services Commission, the agency who oversees the Texas Medicaid program, refers you to the federal CMS HIPAA Administrative Simplification information. However, TMA provides additional guidance with your Medicaid-HIPAA issues.

OFFICE OF CIVIL RIGHTS (OCR) and ENFORCEMENT

The Office of Civil Rights (OCR) is the federal agency under Health & Human Services that is responsible for overseeing and enforcing the HIPAA privacy regulations.

PATIENT DE-IDENTIFICATION LIST

According to the U.S. Department of Health and Human services, when de-identifying a patient, the following identifiers must be removed:

All geographic subdivisions smaller than a state, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of Census:
1.) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people, and
2.) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000;

All elements 0 dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;

  • Telephone numbers
  • Telephone numbers
  • Social Security numbers;
  • Medical record numbers;
  • Health plan beneficiary numbers;
  • Account numbers;
  • Certificate/License numbers;
  • Certificate/License numbers;
  • Vehicle identifiers and serial numbers, including license plate numbers;
  • Device identifiers and serial numbers;
  • Web Universal Resource Locators (URLs);
  • Internet Protocol (IP) address numbers;
  • Biometric identifiers, including finger and voice prints;
  • Full-face photographic images and any comparable images;
  • Any other unique identifying number, characteristic, or code.