Healthcare // Policy & Regulation
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1/7/2014
03:50 PM
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HHS To Strengthen Enforcement Of HIPAA Transaction Rules

Health plans will have until the end of 2015 to get certified for compliance with HIPAA transaction operating rules.

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Ken Terry
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Ken Terry,
User Rank: Apprentice
1/7/2014 | 5:27:42 PM
Re: How much bite?
The fines in the proposed rule are not for healthcare providers but for health plans that don't comply with the operating rules for HIPAA transactions. Most hospital financial and practice management system on the market can spit out claims and claims status/eligibility requests in the required 5010 format today. But health plans that don't comply with operating rules can't necessarily receive that data without tweaking by an intermediary, usually an electronic clearinghouse.
Lorna Garey
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Lorna Garey,
User Rank: Author
1/7/2014 | 5:13:21 PM
How much bite?
Ken, I recall reading a comment from a HC CIO who said it costs his hospital significantly less to pay the fine for HIPAA non-compliance than to implement the controls necessary to come into compliance. And, that's assuming HHS even audits and imposes a fine.

Do you think a percentage of practices are simply going to take such risks, or will the fines be large enough to hurt?
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