Re: Covered Entity or not
Susan, I would argue that it is the health plan's and the patient's benefits that are being coordinated, and not the provider's. If the health plan chooses to do this in its own behalf and/or in behalf of its members, the provider is not a direct party to it, and the provider's HIPAA coveredness is not affected. This does raise the issue of whether or not provider/plan agreements are ever worded in such a way as to make the plan a BA and/or a clearinghouse for this purpose. But I will have to leave that one for the legally trained among us. Marcallee, Any thoughts on this one from a COB and CH expert? - Zon Owen - -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Wednesday, February 05, 2003 2:46 PMTo: WEDI SNIP Privacy Workgroup ListSubject: Covered Entity or not Patricia, Matt, & Zon,I agree with you that when a claim is sent to insurance company A and the claim is then processed and converted into electronic form and paid by Insurance company A, the provider may not be a covered entity based on that. (Except in Texas- my understanding is Texas legislated that any claim, whether on paper or electronic format, makes you a covered entity.) However, when that claim is a forwarded to insurance company B, all bets are off.I reviewed the definition of a clearinghouse as stated by CMS and my understanding, as meager as it may be, is that any time an insurance company forwards a claim to a 2nd insurance carrier for processing, it is acting as a clearinghouse. Nowhere in the definition of clearinghouse does it rule out insurance companies of any kind. The point I was trying to make is, as an example, Medicare acts like a clearinghouse when it forwards a claim, whether submitted to them on paper or electronically, to the 2nd insurance carrier for payment. Does it not? Any insurance carrier that forwards information, in electronic form, to a 2nd insurance carrier for processing of the claim, makes the provider a covered entity. The provider is waiting for 2nd insurance carrier to process the claim and receive payment. Medicare is not the only insurance carrier that forwards claims to a 2nd insurance carrier; it was just the most common example I could think of at this time that most offices could relate too. "ASCA does NOT say that all CE-providers submitting Medicare claims must do so electronically. There are allowances for smaller providers, and there are many of those." ASCA however does require an approved waiver from the Secretary of HHS to send paper claims. I am patiently waiting for the waivers to be posted somewhere so I can get them out to my clients that want to continue submitting claims on paper. I am sure that since the Secretary of HHS must approve them, he will get right on it. Have I missed the application somewhere? Since there is a deadline of months between date of service and when a claim is submitted in order to be paid, when and where I get the waiver approved is an issue.I made no reference to a claim being faxed to any insurance carrier in my earlier example. Just as a side note, according to conversation I had with a regional head of OCR, fax to fax is not a covered transaction but fax to computer is a covered transaction. The data is converted to electronic format by the receiver and/ or same applies to a computer generated fax. It is our understanding, the reason why, whether or not a computer is involved is an issue, is because of electronic theft, hacking, and recent theft of hard drives from institutions like Tricare in the Southwest where hundreds of thousands of military personnel and dependent personal information was stolen.I still believe that all physicians should consider themselves covered entities and operate in that manner. With so many state legislatures and now case law approving HIPAA as "Standard of Care", (recent examples have been shared through Wedi Snip list serve), it makes business sense (cents) to be prepared. I have clients that do electronic claims submission and they did not think they were a covered entity. Boy did they have an eye opening experience. Now consider how many physicians out there, who may or may not realize things they are doing are considered covered transactions. That number scares me. These doctors are not getting the right information nor do they believe it affects them. Thanks,Susan BowesProfessional Procedures & ControlPractice Consulting Firm for the Small Practitioner --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If yo
RE: Covered Entity or not
Susan, I respectfully disagree with the basic premise you have stated below that, “Any insurance carrier that forwards information, in electronic form, to a 2nd insurance carrier for processing of the claim, makes the provider a covered entity.” When a provider sends a paper-claim to the health plan (or its BA: TPA, clearinghouse, “insurance carrier”, etc.), the provider has not conducted a standard, HIPAA electronic transaction, and the provider is not a covered entity. Further, it is my understanding that when insurance carrier “A” forwards that claim (even in a HIPAA-compliant electronic format) to insurance carrier “B” --say, for the sharing of risk-- “A” is NOT doing so on behalf of the provider, rather “A” is doing so on behalf of the health plan. Consequently, the provider is still NOT a CE. I hope that this helps. Your questions are always welcome. Matt Matthew Rosenblum Chief Operations Officer Privacy, Quality Management & Regulatory Affairs CPI Directions, Inc. 10 West 15th Street, Suite 1922 New York, NY 10011 (212) 675-6367 [EMAIL PROTECTED] CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute it. Please notify the sender by E-Mail at the address shown and delete the original message. Thank you. AVISO DEL CONFIDENCIALIDAD: Este email es solamente para el uso del individuo o la entidad a la cual se dirige y puede contener información privilegiada, confidencial y exenta de acceso bajo la ley aplicable. Si usted ha recibido esta comunicación por error, por favor no lo distribuya. Favor notificar al remitennte del E-Mail a la dirección mostrada y elimine el mensaje original. Gracias. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Wednesday, February 05, 2003 2:46 PM To: WEDI SNIP Privacy Workgroup List Subject: Covered Enitity or not Patricia, Matt, & Zon, I agree with you that when a claim is sent to insurance company A and the claim is then processed and converted into electronic form and paid by Insurance company A, the provider may not be a covered entity based on that. (Except in Texas- my understanding is Texas legislated that any claim, whether on paper or electronic format, makes you a covered entity.) However, when that claim is a forwarded to insurance company B, all bets are off. I reviewed the definition of a clearinghouse as stated by CMS and my understanding, as meager as it may be, is that any time an insurance company forwards a claim to a 2nd insurance carrier for processing, it is acting as a clearinghouse. Nowhere in the definition of clearinghouse does it rule out insurance companies of any kind. The point I was trying to make is, as an example, Medicare acts like a clearinghouse when it forwards a claim, whether submitted to them on paper or electronically, to the 2nd insurance carrier for payment. Does it not? Any insurance carrier that forwards information, in electronic form, to a 2nd insurance carrier for processing of the claim, makes the provider a covered entity. The provider is waiting for 2nd insurance carrier to process the claim and receive payment. Medicare is not the only insurance carrier that forwards claims to a 2nd insurance carrier; it was just the most common example I could think of at this time that most offices could relate too. "ASCA does NOT say that all CE-providers submitting Medicare claims must do so electronically. There are allowances for smaller providers, and there are many of those." ASCA however does require an approved waiver from the Secretary of HHS to send paper claims. I am patiently waiting for the waivers to be posted somewhere so I can get them out to my clients that want to continue submitting claims on paper. I am sure that since the Secretary of HHS must approve them, he will get right on it. Have I missed the application somewhere? Since there is a deadline of months between date of service and when a claim is submitted in order to be paid, when and where I get the waiver approved is an issue. I made no reference to a claim being faxed to any insurance carrier in my earlier example. Just as a side note, according to conversation I had with a regional head of OCR, fax to fax is not a covered transaction but fax to computer is a covered transaction. The data is converted to electronic format by the receiver and/ or same applies to a computer generated fax. It is our understanding, the reason why, whether or not a computer is involved is an issue, is because of electronic theft, hacking, and recent theft of hard drives from institutions like Tricare in the Southwest where hundreds of thousands of military personnel and dependent personal information was stolen.
Re: Covered Entity or not
Susan, There are two models of COB. One of these, which I will call Model A, does not require use of a separate COB standard. The X12 837 (claim) transaction allows a provider to report an earlier payer's reimbursement when billing the next payer. That is the Provider-to-Payer-A-to-Provider-to-Payer-B model. Model B, or Provider-to-Payer-A-to-Payer-B COB, is what the COB provisions of the TCS regulations address. Here, again, the X12 837 is used, but now Payer A reports how it paid directly to Payer B, instead of forcing the provider to do so. This is usually done when two payers share a substantial volume of multi-payer claims, such as between a Medicare Payer and a Medicare Supplemental Plan, or between Medicare and Medicaid, or either of those and a local BC/BS Plan. If a provider is using Model A COB, their COB transaction coveredness is essentially a subset of their claims transaction coveredness. If they do any claims electronically, whether with single or multiple payers, they are covered. Under Model B, only the Health Plan's coveredness is an issue. Whether two health plans conduct COB at all is a business decision. If they do so, and also choose to do it electronically, they must use the 837. But that is their choice, and doesn't affect the coveredness of the providers that submitted the associated claims to Payer A. Are their any other thoughts on this out there? - Zon Owen - (808)597-8493 - Original Message - From: [EMAIL PROTECTED] To: WEDI SNIP Privacy Workgroup List Sent: Tuesday, February 04, 2003 6:40 PM Subject: Re: Covered Entity or not Does the HIPAA regulation not mention Coordination of Benefits (COB) as one of the reasons a physician might be a covered entity? How else will COB come into play? Susan Bowes PPC. LLC --- --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
Re: Covered Entity or not
Does the HIPAA regulation not mention Coordination of Benefits (COB) as one of the reasons a physician might be a covered entity? How else will COB come into play? Susan Bowes PPC. LLC --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
RE: Covered Entity or not
From a privacy rule angle: One purpose of the business associate provisions was to make sure that a would-be covered entity does not escape the Privacy Rule by virtue of delegating covered transactions to third parties. Therefore, the determination of covered entity status under the Privacy Rule incorporates the activities of business associates. However, it is not likely that the transactions described below are ones where Medicare, a health plan, is acting as a business associate of a health care provider. That is because the relationship between health care providers and health plans is not, in most cases, a business associate relationship. Health plans do not normally act on behalf of health care providers or provide a service to health care providers when electronically transacting with secondary insurance. Instead they are conducting their own payment activities. As such, their electronic conduct of covered transactions would not affect the status of the health care provider who submitted the claim in the first place. Some relevant preamble excerpts: "We note that health care providers who do not submit HIPAA transactions in standard form become covered by this rule when other entities, such as a billing service or a hospital, transmit standard electronic transactions on their behalf. A provider could not circumvent these requirements by assigning the task to its business associate since the business associate would be considered to be acting on behalf of the provider. See the definition of "business associate. ... The Department recognizes that most covered entities acquire the services of a variety of other persons or entities to assist in carrying covered entities' health care activities. The business associate provisions are necessary to ensure that individually identifiable health information created or shared in the course of these relationships is protected. Further, without the business associate provisions, covered entities would be able to circumvent the requirements of the Privacy Rule simply by contracting out certain of its functions." "The business associate relationship does not describe all relationships between covered entities and other persons or organizations. While we permit uses or disclosures of protected health information for a variety of purposes, business associate contracts or other arrangements are only required for those cases in which the covered entity is disclosing information to someone or some organization that will use the information on behalf of the covered entity, when the other person will be creating or obtaining protected health information on behalf of the covered entity, or when the business associate is providing the specified services to the covered entity and the provision of those services involves the disclosure of protected health information by the covered entity to the business associate. For example, when a health care provider discloses protected health information to health plans for payment purposes, no business associate relationship is established. While the covered provider may have an agreement to accept discounted fees as reimbursement for services provided to health plan members, neither entity is acting on behalf of or providing a service to the other." -- Demetrios Please note: My phone and fax numbers have changed! Demetrios L. Kouzoukas Gardner, Carton & Douglas LLC 1301 K Street NW Suite 900, East Tower Washington, DC 20005-3317 Ph: (202) 230-5119 Fax: (202) 230-5319 Email: [EMAIL PROTECTED] WWW: http://www.gcd.com/firm/bio.asp?empid=K224331082 Assistant: Dee English; (202) 230-5611; [EMAIL PROTECTED] -Original Message- From: Zon Owen [mailto:[EMAIL PROTECTED]] Sent: Monday, February 03, 2003 8:59 PM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or not Jean, That particular aspect is 100% irrelevant for determining HIPAA coveredness. HIPAA coveredness is determined by what you do as an individual entity, with or without the assistance of business associates. What your trading partners do with the data after they receive it is irrelevant. You need to keep in mind that the transactions are conducted between trading partners, which might or might not be business associates for other purposes. COB is a separate business transaction, and whether or not one health plan chooses to conduct COB at all, let alone electronically, with another payer has no effect on a provider's coveredness. - Zon Owen - (808)597-8493 - Original Message - From: [EMAIL PROTECTED] To: WEDI SNIP Privacy Workgroup <mailto:[EMAIL PROTECTED]> List Sent: Monday, February 03, 2003 1:06 PM Subject: Re: Covered Entity or not Susan, What a great mind you have (and I am not being facetious!)...never would have thought about Medicare electronically submitting to secondary insurance/Medigap! Guess that
Re: Covered Entity or not
Jean, That particular aspect is 100% irrelevant for determining HIPAA coveredness. HIPAA coveredness is determined by what you do as an individual entity, with or without the assistance of business associates. What your trading partners do with the data after they receive it is irrelevant. You need to keep in mind that the transactions are conducted between trading partners, which might or might not be business associates for other purposes. COB is a separate business transaction, and whether or not one health plan chooses to conduct COB at all, let alone electronically, with another payer has no effect on a provider's coveredness. - Zon Owen - (808)597-8493 - Original Message - From: [EMAIL PROTECTED] To: WEDI SNIP Privacy Workgroup List Sent: Monday, February 03, 2003 1:06 PM Subject: Re: Covered Entity or not Susan, What a great mind you have (and I am not being facetious!)...never would have thought about Medicare electronically submitting to secondary insurance/Medigap! Guess that does snag a lot of small physician practices in the "covered entity" net. Anyone disagree?Jean Acevedo, LHRM, CPC, CHCSubj: Covered Entity or notDate: 2/3/2003 10:19:41 AM Eastern Standard TimeFrom: [EMAIL PROTECTED]To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]>Reply-To: [EMAIL PROTECTED] Everyone, We can argue all day long whether or not we are a covered entity, but I think it makes good business decision to agree that you are if you send in claims and be done with it. Look at this situation, I don't know if many doctors or support staff realize this: Anytime a claim is sent to Medicare, paper or electronic, it is converted into an electronic transaction because Medicare forwards it to 2nd insurance companies. So now you are a covered entity. The only way to get out of sending claims to Medicare is not to treat anyone who may have Medicare. Who can afford to refuse to treat a large portion of our society. Another kink- Medicare requires the doctor to file the claim for the patient so don't think you can give the claim to the patient and he files it for you. The loop holes for not being a covered entity is so small, you almost have to practicing in the dark ages to not be a covered entity. I think you just have to resign yourself that if you practice and treat patient whether cash practice or not, you ARE A COVERED ENTITY. At least that is what I am advising our clients, better safe than sorry. Thanks, Susan BowesProfessional Procedures & ControlPractice Consulting Firm for the Small Practitioner --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
Re: Covered Entity or not
Susan, What a great mind you have (and I am not being facetious!)...never would have thought about Medicare electronically submitting to secondary insurance/Medigap! Guess that does snag a lot of small physician practices in the "covered entity" net. Anyone disagree? Jean Acevedo, LHRM, CPC, CHC > > Subj: Covered Entity or not > Date: 2/3/2003 10:19:41 AM Eastern Standard Time > From: [EMAIL PROTECTED] > To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> > Reply-To: [EMAIL PROTECTED] > Sent from the Internet (Details) > > > Everyone, > We can argue all day long whether or not we are a covered entity, but I think it >makes good business decision to agree that you are if you send in claims and be done >with it. > > Look at this situation, I don't know if many doctors or support staff realize this: >Anytime a claim is sent to Medicare, paper or electronic, it is coverted into an >electronic transaction because Medicare forwards it to 2nd insurance companies. So >now you are a covered entity. The only way to get out of sending claims to Medicare >is not to treat anyone who may have Medicare. Who can afford to refuse to treat a >large portion of our society. Another kink- Medicare requires the doctor to file the >claim for the patient so don't think you can give the claim to the patient and he >files it for you. > > The loop holes for not being a covered entity is so small, you almost have to >practicing in the dark ages to not be a covered entity. > > I think you just have to resign yourself that if you practice and treat patient >whether cash practice or not, you ARE A COVERED ENTITY. At least that is what I am >advising our > clients, better safe than sorry. > > Thanks, > > Susan Bowes > Professional Procedures & Control > Practice Consulting Firm for the Small Practioner --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
Fw: Covered Entity or not
Title: Message Another thought -- we have exchanged many words on what is "Health Care", especially with respect to Medicaid. Here's my simplified version -- It's "Health Care" if you expect a Health Plan to pay for it (in the case of Medicaid, which doesn't necessarily act as only a Health Plan, possibly extended to if you don't expect any other Health Plans to cover it, it may not be to the Medicaid carrier either). The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. WebbComputer System EngineerLittle Company of Mary Hospital & Health Care Centers[EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s) named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately, delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." - Original Message - From: Doug Webb To: WEDI SNIP Privacy Workgroup List Sent: Monday, February 03, 2003 11:37 AM Subject: Fw: Covered Entity or not I agree -- no bill is the same as cash in my book. The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. WebbComputer System EngineerLittle Company of Mary Hospital & Health Care Centers[EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s) named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately, delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." - Original Message - From: Mendel, Linda R. To: 'Doug Webb' Sent: Monday, February 03, 2003 11:05 AM Subject: RE: Covered Entity or not I think one category of CE that will stay uncovered at least for a while is employer sponsored on site medical clinics that don't bill at all. -Original Message-From: Doug Webb [mailto:[EMAIL PROTECTED]] Sent: Monday, February 03, 2003 11:57 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Re: Covered Entity or not Susan, Well said. Still another kink -- come October, you will have to file your Medicare claims electronically, which makes the loopholes even smaller. IMHO, this makes just about anyoune who does "Health Care" a CE, except for those few providers who do a strictly cash business, and never file a claim with anyone. I kind of expect that in another few years, large numbers of payors other than Medicare will be rejecting paper claims. The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. WebbComputer System EngineerLittle Company of Mary Hospital & Health Care Centers[EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s) named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately, delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." - Original Message - From: [EMAIL PROTECTED] To: WEDI SNIP Privacy Workgroup List Sent: Monday, February 03, 2003 09:19 AM Subject: Covered Entity or not Everyone,We can argue all day long whether or not we are a covered entity, but I think it makes good business decision to agree that you are if you send in claims and be done with it.Look at this situation, I don't know if many doctors or support staff realize this: Anytime a claim is sent to Medicare, paper or electronic, it is coverted into an electronic transaction because Medicare forwards it to 2nd insurance companies. So now you are a covered entity. The only way to get out of sending claims to Medicare is not to treat anyone who may have Medicare. Who can afford to refuse to treat a large portion of our society. Another kink- Medicare requires the doctor to file the claim for the patient so don't think you can give the claim to th
RE: Covered Entity or not
Doug and Susan, Not so fast, please: 1) ASCA does NOT say that all CE-providers submitting Medicare claims must do so electronically. There are allowances for smaller providers, and there are many of those. 2) What follows is a quote in an e-mail that I received on November 27, 2003 from Stanley Nachimson from the CMS Office of HIPAA Standards. Mr. Nachimson and I were discussing this exact topic of whether or not a provider faxing a paper-claim directly to a health plan (or its clearinghouse or TPA) would define the provider as a covered entity: “If a provider is faxing a claim to the business associate of the health plan (whether that is a clearinghouse or TPA), the provider has conducted the transaction entirely thru fax, and is not a covered entity. If the provider contracts with someone (which then becomes the provider's business associate) to translate the claim from fax to electronic standard before submission to the health plan (or the health plan's business associate), then the provider becomes a covered entity. Again, what matters is where in the transaction does the translation take place - before or after submission to the health plan (or its BA).” I hope that this helps. Your questions are always welcome. Matt Matthew Rosenblum Chief Operations Officer Privacy, Quality Management & Regulatory Affairs http://www.CPIdirections.com CPI Directions, Inc. 10 West 15th Street, Suite 1922 New York, NY 10011 (212) 675-6367 [EMAIL PROTECTED] CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute it. Please notify the sender by E-Mail at the address shown and delete the original message. Thank you. AVISO DEL CONFIDENCIALIDAD: Este email es solamente para el uso del individuo o la entidad a la cual se dirige y puede contener información privilegiada, confidencial y exenta de acceso bajo la ley aplicable. Si usted ha recibido esta comunicación por error, por favor no lo distribuya. Favor notificar al remitente del E-Mail a la dirección mostrada y elimine el mensaje original. Gracias. -Original Message- From: Doug Webb [mailto:[EMAIL PROTECTED]] Sent: Monday, February 03, 2003 11:57 AM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or not Susan, Well said. Still another kink -- come October, you will have to file your Medicare claims electronically, which makes the loopholes even smaller. IMHO, this makes just about anyoune who does "Health Care" a CE, except for those few providers who do a strictly cash business, and never file a claim with anyone. I kind of expect that in another few years, large numbers of payors other than Medicare will be rejecting paper claims. The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. Webb Computer System Engineer Little Company of Mary Hospital & Health Care Centers [EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s) named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately, delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." - Original Message - From: [EMAIL PROTECTED] To: WEDI SNIP Privacy Workgroup List Sent: Monday, February 03, 2003 09:19 AM Subject: Covered Entity or not Everyone, We can argue all day long whether or not we are a covered entity, but I think it makes good business decision to agree that you are if you send in claims and be done with it. Look at this situation, I don't know if many doctors or support staff realize this: Anytime a claim is sent to Medicare, paper or electronic, it is coverted into an electronic transaction because Medicare forwards it to 2nd insurance companies. So now you are a covered entity. The only way to get out of sending claims to Medicare is not to treat anyone who may have Medicare. Who can afford to refuse to treat a large portion of our society. Another kink- Medicare requires the doctor to file the claim for the patient so don't think you can give the claim to the patient and he files it for you. The loop holes for not being a covered entity is so small, you almost have to practicing in the dark ages to not be a covered entity. I think you just have to resign yourself that if you practice and treat
Fw: Covered Entity or not
Title: Message I agree -- no bill is the same as cash in my book. The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. WebbComputer System EngineerLittle Company of Mary Hospital & Health Care Centers[EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s) named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately, delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." - Original Message - From: Mendel, Linda R. To: 'Doug Webb' Sent: Monday, February 03, 2003 11:05 AM Subject: RE: Covered Entity or not I think one category of CE that will stay uncovered at least for a while is employer sponsored on site medical clinics that don't bill at all. -Original Message-From: Doug Webb [mailto:[EMAIL PROTECTED]] Sent: Monday, February 03, 2003 11:57 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Re: Covered Entity or not Susan, Well said. Still another kink -- come October, you will have to file your Medicare claims electronically, which makes the loopholes even smaller. IMHO, this makes just about anyoune who does "Health Care" a CE, except for those few providers who do a strictly cash business, and never file a claim with anyone. I kind of expect that in another few years, large numbers of payors other than Medicare will be rejecting paper claims. The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. WebbComputer System EngineerLittle Company of Mary Hospital & Health Care Centers[EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s) named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately, delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." - Original Message - From: [EMAIL PROTECTED] To: WEDI SNIP Privacy Workgroup List Sent: Monday, February 03, 2003 09:19 AM Subject: Covered Entity or not Everyone,We can argue all day long whether or not we are a covered entity, but I think it makes good business decision to agree that you are if you send in claims and be done with it.Look at this situation, I don't know if many doctors or support staff realize this: Anytime a claim is sent to Medicare, paper or electronic, it is coverted into an electronic transaction because Medicare forwards it to 2nd insurance companies. So now you are a covered entity. The only way to get out of sending claims to Medicare is not to treat anyone who may have Medicare. Who can afford to refuse to treat a large portion of our society. Another kink- Medicare requires the doctor to file the claim for the patient so don't think you can give the claim to the patient and he files it for you. The loop holes for not being a covered entity is so small, you almost have to practicing in the dark ages to not be a covered entity. I think you just have to resign yourself that if you practice and treat patient whether cash practice or not, you ARE A COVERED ENTITY. At least that is what I am advising our clients, better safe than sorry.Thanks,Susan BowesProfessional Procedures & ControlPractice Consulting Firm for the Small PractionerContact info:211 Turner DriveReidsville, NC 27320Phone- 336-578-7461Fax- 336-578-7461 or 336-342-2030---The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional co
Re: Covered Entity or not
Susan, Well said. Still another kink -- come October, you will have to file your Medicare claims electronically, which makes the loopholes even smaller. IMHO, this makes just about anyoune who does "Health Care" a CE, except for those few providers who do a strictly cash business, and never file a claim with anyone. I kind of expect that in another few years, large numbers of payors other than Medicare will be rejecting paper claims. The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. WebbComputer System EngineerLittle Company of Mary Hospital & Health Care Centers[EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s) named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately, delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." - Original Message - From: [EMAIL PROTECTED] To: WEDI SNIP Privacy Workgroup List Sent: Monday, February 03, 2003 09:19 AM Subject: Covered Entity or not Everyone,We can argue all day long whether or not we are a covered entity, but I think it makes good business decision to agree that you are if you send in claims and be done with it.Look at this situation, I don't know if many doctors or support staff realize this: Anytime a claim is sent to Medicare, paper or electronic, it is coverted into an electronic transaction because Medicare forwards it to 2nd insurance companies. So now you are a covered entity. The only way to get out of sending claims to Medicare is not to treat anyone who may have Medicare. Who can afford to refuse to treat a large portion of our society. Another kink- Medicare requires the doctor to file the claim for the patient so don't think you can give the claim to the patient and he files it for you. The loop holes for not being a covered entity is so small, you almost have to practicing in the dark ages to not be a covered entity. I think you just have to resign yourself that if you practice and treat patient whether cash practice or not, you ARE A COVERED ENTITY. At least that is what I am advising our clients, better safe than sorry.Thanks,Susan BowesProfessional Procedures & ControlPractice Consulting Firm for the Small PractionerContact info:211 Turner DriveReidsville, NC 27320Phone- 336-578-7461Fax- 336-578-7461 or 336-342-2030---The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED]To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED]If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
RE: Covered Entity or Not
I would like to ask the group a related, but varied question, regarding hybrid and affiliated entities. Two scenarios: 1) Skilled Nursing facility has attached assisted living, with same ownership (lets say we call this a single legal entity). (Of course, the nursing facility is Medicare/Medicaid certified, and the assisted living is state certified.) Assisted living does not conduct any electronic transactions (all is done on paper), nursing facility does conduct electronic transactions. The two are distinct parts, offering distinct services. Is this a hybrid situation? If so, I assume this should be documented. 2) Same situation, except 2 nursing facilities, and 2 assisted living, separate legal entities, under common ownership as defined by the rule. May the two facilities designate themselves as affiliated covered entities? Should they include the assisted living as part of that designation? Can they avoid designating the assisted living as a covered component or entity? I've got a handle on this Privacy thing, and even the covered entity thing, but have just recently had questions regarding the definition of hybrid and affiliated entities. Seems a little tricky to me, depending upon one's interpretation. Any input will be appreciated. Thanks. -Original Message- From: Scott F Kimbel [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 02, 2003 10:22 PM To: WEDI SNIP Privacy Workgroup List Subject: RE: Covered Entity or Not William, This question always come up in my seminars, my standard answer is, you may not have to legally comply, however HIPAA is meant to be best business practices, it's meant to protect a patients privacy. Think about it this way, on April 15 it's estimated over 10 million Notices of Privacy practice will be sent out or acknowledged. You can bet a single consumer will receive several, all indicating how each particular healthcare provider will protect their personal health information. Maybe they won't care that a particular provider doesn't give them one of these documents, they will probably still hold them to the standard. BTW the definition of "in electronic form" is as follows (from CMS) In Electronic Form Using electronic media, as that term is defined at 45 C.F.R. 162.103. It includes 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. Hope this helps, Scott Kimbel Kimbel Morrow and Associates Inc. 866-598-2593 -Original Message- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 02, 2003 11:54 AM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not I believe you - I've heard nonsense interpretations along those lines in the past, too. But I have a solution. In order for my chiropractor to avoid sanctions and penalties for sending his electronic transaction via his computer fax without using the standard X12 format, he can instead fax it to a heavily capitalized clearinghouse with a large IT staff. Since the clearinghouse can operate as a non-covered entity whenever it damn well pleases, it can print out the fax and mail it to the payer for 35¢ plus postage. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 - Original Message - From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Sunday, 02 February, 2003 02:32 PM Subject: RE: Covered Entity or Not According to CMS, yes, this scenario would constitute an electronic transaction, and thus be subject to HIPAA requirements. This topic was discussed a few weeks ago on another SNIP list (can't recall which one) and HIPAAlive, I think. Zon Owen responded with a message that attempted to bring insight into CMS' thinking about why this would be electronic transactions - something along the lines of this being computer-to-computer and thus electronic. William, you're good with the archives of these lists - I bet you can find the thread in a heartbeat! Don't yell at meI think this is one of the most ludicrous things amongst myriad HIPAA ludicrous stuff. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] -Original Message- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 02, 2003 11:52 AM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not So, let's say I'm a part-time chiropractor and I have occasion to send in a dozen or so claims a week. I get tired of hand-fill
Covered Entity or not
Everyone, We can argue all day long whether or not we are a covered entity, but I think it makes good business decision to agree that you are if you send in claims and be done with it. Look at this situation, I don't know if many doctors or support staff realize this: Anytime a claim is sent to Medicare, paper or electronic, it is coverted into an electronic transaction because Medicare forwards it to 2nd insurance companies. So now you are a covered entity. The only way to get out of sending claims to Medicare is not to treat anyone who may have Medicare. Who can afford to refuse to treat a large portion of our society. Another kink- Medicare requires the doctor to file the claim for the patient so don't think you can give the claim to the patient and he files it for you. The loop holes for not being a covered entity is so small, you almost have to practicing in the dark ages to not be a covered entity. I think you just have to resign yourself that if you practice and treat patient whether cash practice or not, you ARE A COVERED ENTITY. At least that is what I am advising our clients, better safe than sorry. Thanks, Susan Bowes Professional Procedures & Control Practice Consulting Firm for the Small Practioner Contact info: 211 Turner Drive Reidsville, NC 27320 Phone- 336-578-7461 Fax- 336-578-7461 or 336-342-2030 --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
RE: Covered Entity or Not
This message thread is the real heart of HIPAA. Whether you believe the intent of HIPAA is to save money (long term) or to protect privacy or as I believe, to do both. It also speaks of the intent of the organization. Is its focus to save money and protect privacy or just to save money? Dale W. Pocklington, MS, MHA, CISSP, CDIA, CCA Senior Project Manager The EDI Project, Inc. 619.607.2745 www.TheEDIproject.com [EMAIL PROTECTED] or [EMAIL PROTECTED] Scott F Kimbel <[EMAIL PROTECTED]> wrote: William,This question always come up in my seminars, my standard answer is, youmay not have to legally comply, however HIPAA is meant to be bestbusiness practices, it's meant to protect a patients privacy. Thinkabout it this way, on April 15 it's estimated over 10 million Notices ofPrivacy practice will be sent out or acknowledged. You can bet a singleconsumer will receive several, all indicating how each particularhealthcare provider will protect their personal health information.Maybe they won't care that a particular provider doesn't give them oneof these documents, they will probably still hold them to the standard.BTW the definition of "in electronic form" is as follows (from CMS)In Electronic FormUsing electronic media, as that term is defined at 45 C.F.R. 162.103. Itincludes transmissions over the Internet (wide-open), Extranet (usingInternet technology to link a business with information only accessibleto collaborating parties), leased lines, dial-up lines, and privatenetworks, and those transmissions that are physically moved from onelocation to another using magnetic tape, disk, or CD media.Hope this helps,Scott KimbelKimbel Morrow and Associates Inc.866-598-2593-Original Message-From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 02, 2003 11:54 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Re: Covered Entity or NotI believe you - I've heard nonsense interpretations along those lines inthe past, too. But I have a solution. In order for my chiropractor toavoid sanctions and penalties for sending his electronic transaction viahis computer fax without using the standard X12 format, he can insteadfax it to a heavily capitalized clearinghouse with a large IT staff.Since the clearinghouse can operate as a non-covered entity whenever itdamn well pleases, it can print out the fax and mail it to the payer for35¢ plus postage.William J. KammererNovannet, LLC.Columbus, US-OH 43221-3859+1 (614) 487-0320- Original Message -From: "Rachel Foerster" <[EMAIL PROTECTED]>To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]>Sent: Sunday, 02 February, 2003 02:32 PMSubject: RE: Covered Entity or NotAccording to CMS, yes, this scenario would constitute an electronictransaction, and thus be subject to HIPAA requirements. This topic wasdiscussed a few weeks ago on another SNIP list (can't recall which one)and HIPAAlive, I think. Zon Owen responded with a message that attemptedto bring insight into CMS' thinking about why this would be electronictransactions - something along the lines of this beingcomputer-to-computer and thus electronic. William, you're good with thearchives of these lists - I bet you can find the thread in a heartbeat!Don't yell at meI think this is one of the most ludicrous thingsamongst myriad HIPAA ludicrous stuff.Rachel FoersterPrincipalRachel Foerster & Associates, Ltd.Professionals in Health Care EDI39432 North AvenueBeach Park, IL 60099Voice: 847-872-8070Fax: 847-872-6860eMail: [EMAIL PROTECTED]-Original Message-From: William J. Kammerer [mailto:[EMAIL PROTECTED]]Sent: Sunday, February 02, 2003 11:52 AMTo: WEDI SNIP Privacy Workgroup ListSubject: Re: Covered Entity or NotSo, let's say I'm a part-time chiropractor and I have occasion to sendin a dozen or so claims a week. I get tired of hand-filling in the HCFA1500, so I get a Word document template for the form and key data in,perhaps with the aid of a macro. Then I use my Fax software on my laptopto send the image of the Word document to the payer. Does that count asan electronic transaction? Does that now make me a covered entity? WillI now get in trouble, facing onerous fines and penalties?That would be a hoot, considering that Clearinghouses think they can(and undoubtedly will) "dump" claims to paper - even when providers sendelectronic transactions to them in the first place! The clearinghousesimply says it's not a covered entity for the moment!Where's the justice (or administrative simplification) in all of this?What kind of Bizarro world is this?William J. KammererNovannet, LLC.Columbus, US-OH 43221-3859+1 (614) 487-0320- Original Message -From: "Rachel Foerster" <[EMAIL PROTECTED]>To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]>Sent: Sunday, 02 February, 2003 12:10 PMSubject: RE: Covered Entity or NotFax is considered an electronic transaction by CMS if the documentoriginated as an electronic document in a computer system and is faxedfrom that computer system.Rachel Foers
RE: Covered Entity or Not
William, This question always come up in my seminars, my standard answer is, you may not have to legally comply, however HIPAA is meant to be best business practices, it's meant to protect a patients privacy. Think about it this way, on April 15 it's estimated over 10 million Notices of Privacy practice will be sent out or acknowledged. You can bet a single consumer will receive several, all indicating how each particular healthcare provider will protect their personal health information. Maybe they won't care that a particular provider doesn't give them one of these documents, they will probably still hold them to the standard. BTW the definition of "in electronic form" is as follows (from CMS) In Electronic Form Using electronic media, as that term is defined at 45 C.F.R. 162.103. It includes 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. Hope this helps, Scott Kimbel Kimbel Morrow and Associates Inc. 866-598-2593 -Original Message- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 02, 2003 11:54 AM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not I believe you - I've heard nonsense interpretations along those lines in the past, too. But I have a solution. In order for my chiropractor to avoid sanctions and penalties for sending his electronic transaction via his computer fax without using the standard X12 format, he can instead fax it to a heavily capitalized clearinghouse with a large IT staff. Since the clearinghouse can operate as a non-covered entity whenever it damn well pleases, it can print out the fax and mail it to the payer for 35¢ plus postage. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 - Original Message - From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Sunday, 02 February, 2003 02:32 PM Subject: RE: Covered Entity or Not According to CMS, yes, this scenario would constitute an electronic transaction, and thus be subject to HIPAA requirements. This topic was discussed a few weeks ago on another SNIP list (can't recall which one) and HIPAAlive, I think. Zon Owen responded with a message that attempted to bring insight into CMS' thinking about why this would be electronic transactions - something along the lines of this being computer-to-computer and thus electronic. William, you're good with the archives of these lists - I bet you can find the thread in a heartbeat! Don't yell at meI think this is one of the most ludicrous things amongst myriad HIPAA ludicrous stuff. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] -Original Message- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 02, 2003 11:52 AM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not So, let's say I'm a part-time chiropractor and I have occasion to send in a dozen or so claims a week. I get tired of hand-filling in the HCFA 1500, so I get a Word document template for the form and key data in, perhaps with the aid of a macro. Then I use my Fax software on my laptop to send the image of the Word document to the payer. Does that count as an electronic transaction? Does that now make me a covered entity? Will I now get in trouble, facing onerous fines and penalties? That would be a hoot, considering that Clearinghouses think they can (and undoubtedly will) "dump" claims to paper - even when providers send electronic transactions to them in the first place! The clearinghouse simply says it's not a covered entity for the moment! Where's the justice (or administrative simplification) in all of this? What kind of Bizarro world is this? William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 - Original Message - From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Sunday, 02 February, 2003 12:10 PM Subject: RE: Covered Entity or Not Fax is considered an electronic transaction by CMS if the document originated as an electronic document in a computer system and is faxed from that computer system. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] http://www.rfa-edi.com
Re: Covered Entity or Not
Charles, You will need to consider each of the affected business transactions, and you will also need to consider whether or not any of those transactions are done electronically by others, such as billing services, in your behalf. HIPAA does not require that a provider use any of the electronic transaction standards unless they are conducting the associated underlying business processes electronically, with fax* and voice-over-telephone not being considered electronic. For HIPAA purposes, a fax would be considered electronic if it was sent from one computer to another. If that was done as part of one of the defined transactions, then that would make you covered. Similarly, sending information that accomplishes one of those purposes via e-mail, or in a Word document, or as a portable document file (pdf), would be an electronic exchange. Also, keep in mind that we are discussing specific business transactions here; whether or not your exchanges include PHI is not relevant to the coveredness determination. So, let's go down the list: If you do not submit either claims of the equivalent encounter information electronically, you may be OK. But are you sure that no one else, such as a billing service, does any electronic billing or posting for you? If you dispense drugs, are those also billed manually? If the only way that you check on patient eligibility is by making a phone call, or by mailing a form, you may be OK. But how do you carry out this business process? If you use e-mail, or a web page, you're covered. If the only way that you check on the status of a previously submitted claim is by making a phone call, or by mailing a form, you may be OK. But how do you carry out this business process? If you use an e-mail or a payer's web page to check this, that's electronic. If the only way that you apply for a referral certification or authorization is by making a phone call, or by mailing a form, you may be OK. But how do you carry out this business process? If you receive all of your payments from health plans on check and all of your explanations of those payments from them on paper, then you may be OK. But does a billing service or a bank do any of your payment processing for you? If so, do they do any of that electronically? If you are not doing any of the previously listed transactions electronically with anyone, then it is highly unlikely that you are using any of the others, but those "others" would include the following: - Enrollment & Disenrollment in a health plan. - Payment of premiums to a health plan. - Coordination of Benefits with a health plan (this is usually done between health plans). - Claim Attachments (no rule has been published yet, so it shouldn't be relevant yet). - First Report of Injury (no rule has been published yet, so it shouldn't be relevant yet). So, in summary, none of the HIPAA Administrative Simplification provisions, including privacy and security, will apply to you if you really don't do any of these processes electronically. But you cannot be conducting any of the above transactions electronically, and no one else can be doing any of them in your behalf. And you would still need to manage your privacy and security risks, and many other federal and state laws affect your requirements for those. Hope that helps! - Zon Owen - (808)597-8493 - Original Message - From: [EMAIL PROTECTED]To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]>Sent: Fri, 31 Jan 2003 10:57:47 -0500Subject: Covered Entity or NotAt a meeting yesterday of our parent organization's privacy officers we had a discussion I'd appreciate some feedback on. One of the organizations is a long-term care/retirement facility that indicated they do not "bill" electronically. Therefore they are not a covered entity. However, after further discussion, they indicated they do in fact send via fax and/or email individual identifiable health information to other covered entities (i.e. hospitals, referral agencies, and referring agencies). Some contended because they did not use EDI, they didn't really need to comply, others indicated they were because they do send PHI via electronic media.Can anyone provide an insight?Thanks.Charles. Charles R. Carnahan, M.Div., M.B.A.Chief Operating OfficerCAB Health and Recovery Services, Inc.111 Middleton RoadDanvers, MA 01923Phone: 978-739-7600FAX: 978-750-3620www.cabhealth.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial ma
Re: Covered Entity or Not
I believe you - I've heard nonsense interpretations along those lines in the past, too. But I have a solution. In order for my chiropractor to avoid sanctions and penalties for sending his electronic transaction via his computer fax without using the standard X12 format, he can instead fax it to a heavily capitalized clearinghouse with a large IT staff. Since the clearinghouse can operate as a non-covered entity whenever it damn well pleases, it can print out the fax and mail it to the payer for 35¢ plus postage. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 - Original Message - From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Sunday, 02 February, 2003 02:32 PM Subject: RE: Covered Entity or Not According to CMS, yes, this scenario would constitute an electronic transaction, and thus be subject to HIPAA requirements. This topic was discussed a few weeks ago on another SNIP list (can't recall which one) and HIPAAlive, I think. Zon Owen responded with a message that attempted to bring insight into CMS' thinking about why this would be electronic transactions - something along the lines of this being computer-to-computer and thus electronic. William, you're good with the archives of these lists - I bet you can find the thread in a heartbeat! Don't yell at meI think this is one of the most ludicrous things amongst myriad HIPAA ludicrous stuff. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] -Original Message- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 02, 2003 11:52 AM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not So, let's say I'm a part-time chiropractor and I have occasion to send in a dozen or so claims a week. I get tired of hand-filling in the HCFA 1500, so I get a Word document template for the form and key data in, perhaps with the aid of a macro. Then I use my Fax software on my laptop to send the image of the Word document to the payer. Does that count as an electronic transaction? Does that now make me a covered entity? Will I now get in trouble, facing onerous fines and penalties? That would be a hoot, considering that Clearinghouses think they can (and undoubtedly will) "dump" claims to paper - even when providers send electronic transactions to them in the first place! The clearinghouse simply says it's not a covered entity for the moment! Where's the justice (or administrative simplification) in all of this? What kind of Bizarro world is this? William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 - Original Message - From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Sunday, 02 February, 2003 12:10 PM Subject: RE: Covered Entity or Not Fax is considered an electronic transaction by CMS if the document originated as an electronic document in a computer system and is faxed from that computer system. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] http://www.rfa-edi.com -Original Message- From: Noel Chang [mailto:[EMAIL PROTECTED]] Sent: Saturday, February 01, 2003 8:19 PM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not Charles, The definition of a "covered entity" entails more than just filing electronic claims. There are several "covered transactions" and if you conduct any of them electronically then you are a CE and must comply with HIPAA. For a complete list of "covered transactions" refer to the Transaction and Code Set Standards. I would also note that the definition of conducting a transaction "electronically" is often debated. I know HHS has indicated in the preamble to the Privacy Rule that a fax does not count as electronic transmission. Noel Chang -- Open WebMail Project (http://openwebmail.org) ----- Original Message - From: <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Friday, 31 January, 2003 10:57 AM Subject: Covered Entity or Not At a meeting yesterday of our parent organization's privacy officers we had a discussion I'd appreciate some feedback on. One of the organizations is a long-term care/retirement facility that indicated they do not "bill" electronically. Therefore they are not a covered entity. However, after further discussion they indicated they do in fact send via fax and/or email individual identifia
RE: Covered Entity or Not
According to CMS, yes, this scenario would constitute an electronic transaction, and thus be subject to HIPAA requirements. This topic was discussed a few weeks ago on another SNIP list (can't recall which one) and HIPAAlive, I think. Zon Owen responded with a message that attempted to bring insight into CMS' thinking about why this would be electronic transactions - something along the lines of this being computer-to-computer and thus electronic. William, you're good with the archives of these lists - I bet you can find the thread in a heartbeat! Don't yell at meI think this is one of the most ludicrous things amongst myriad HIPAA ludicrous stuff. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] -Original Message- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 02, 2003 11:52 AM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not So, let's say I'm a part-time chiropractor and I have occasion to send in a dozen or so claims a week. I get tired of hand-filling in the HCFA 1500, so I get a Word document template for the form and key data in, perhaps with the aid of a macro. Then I use my Fax software on my laptop to send the image of the Word document to the payer. Does that count as an electronic transaction? Does that now make me a covered entity? Will I now get in trouble, facing onerous fines and penalties? That would be a hoot, considering that Clearinghouses think they can (and undoubtedly will) "dump" claims to paper - even when providers send electronic transactions to them in the first place! The clearinghouse simply says it's not a covered entity for the moment! Where's the justice (or administrative simplification) in all of this? What kind of Bizarro world is this? William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 - Original Message - From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Sunday, 02 February, 2003 12:10 PM Subject: RE: Covered Entity or Not Fax is considered an electronic transaction by CMS if the document originated as an electronic document in a computer system and is faxed from that computer system. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] http://www.rfa-edi.com -Original Message- From: Noel Chang [mailto:[EMAIL PROTECTED]] Sent: Saturday, February 01, 2003 8:19 PM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not Charles, The definition of a "covered entity" entails more than just filing electronic claims. There are several "covered transactions" and if you conduct any of them electronically then you are a CE and must comply with HIPAA. For a complete list of "covered transactions" refer to the Transaction and Code Set Standards. I would also note that the definition of conducting a transaction "electronically" is often debated. I know HHS has indicated in the preamble to the Privacy Rule that a fax does not count as electronic transmission. Noel Chang -- Open WebMail Project (http://openwebmail.org) - Original Message - From: <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Friday, 31 January, 2003 10:57 AM Subject: Covered Entity or Not At a meeting yesterday of our parent organization's privacy officers we had a discussion I'd appreciate some feedback on. One of the organizations is a long-term care/retirement facility that indicated they do not "bill" electronically. Therefore they are not a covered entity. However, after further discussion they indicated they do in fact send via fax and/or email individual identifiable health information to other covered entities (ie hospitals, referral agencies, and referring agencies). Some contended because they did not use EDI, they didn't really need to comply, others indicated they were because they do send PHI via electronic media. Can anyone provide an insight? Thanks. Charles. Charles R. Carnahan, M.Div., M.B.A. Chief Operating Officer CAB Health and Recovery Services, Inc. 111 Middleton Road Danvers, MA 01923 Phone: 978-739-7600 FAX: 978-750-3620 www.cabhealth.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an off
Re: Covered Entity or Not
So, let's say I'm a part-time chiropractor and I have occasion to send in a dozen or so claims a week. I get tired of hand-filling in the HCFA 1500, so I get a Word document template for the form and key data in, perhaps with the aid of a macro. Then I use my Fax software on my laptop to send the image of the Word document to the payer. Does that count as an electronic transaction? Does that now make me a covered entity? Will I now get in trouble, facing onerous fines and penalties? That would be a hoot, considering that Clearinghouses think they can (and undoubtedly will) "dump" claims to paper - even when providers send electronic transactions to them in the first place! The clearinghouse simply says it's not a covered entity for the moment! Where's the justice (or administrative simplification) in all of this? What kind of Bizarro world is this? William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 - Original Message - From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Sunday, 02 February, 2003 12:10 PM Subject: RE: Covered Entity or Not Fax is considered an electronic transaction by CMS if the document originated as an electronic document in a computer system and is faxed from that computer system. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] http://www.rfa-edi.com -Original Message- From: Noel Chang [mailto:[EMAIL PROTECTED]] Sent: Saturday, February 01, 2003 8:19 PM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not Charles, The definition of a "covered entity" entails more than just filing electronic claims. There are several "covered transactions" and if you conduct any of them electronically then you are a CE and must comply with HIPAA. For a complete list of "covered transactions" refer to the Transaction and Code Set Standards. I would also note that the definition of conducting a transaction "electronically" is often debated. I know HHS has indicated in the preamble to the Privacy Rule that a fax does not count as electronic transmission. Noel Chang -- Open WebMail Project (http://openwebmail.org) - Original Message - From: <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Friday, 31 January, 2003 10:57 AM Subject: Covered Entity or Not At a meeting yesterday of our parent organization's privacy officers we had a discussion I'd appreciate some feedback on. One of the organizations is a long-term care/retirement facility that indicated they do not "bill" electronically. Therefore they are not a covered entity. However, after further discussion they indicated they do in fact send via fax and/or email individual identifiable health information to other covered entities (ie hospitals, referral agencies, and referring agencies). Some contended because they did not use EDI, they didn't really need to comply, others indicated they were because they do send PHI via electronic media. Can anyone provide an insight? Thanks. Charles. Charles R. Carnahan, M.Div., M.B.A. Chief Operating Officer CAB Health and Recovery Services, Inc. 111 Middleton Road Danvers, MA 01923 Phone: 978-739-7600 FAX: 978-750-3620 www.cabhealth.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
RE: Covered Entity or Not
Fax is considered an electronic transaction by CMS if the document originated as an electronic document in a computer system and is faxed from that computer system. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in Health Care EDI 39432 North Avenue Beach Park, IL 60099 Voice: 847-872-8070 Fax: 847-872-6860 eMail: [EMAIL PROTECTED] http://www.rfa-edi.com -Original Message- From: Noel Chang [mailto:[EMAIL PROTECTED]] Sent: Saturday, February 01, 2003 8:19 PM To: WEDI SNIP Privacy Workgroup List Subject: Re: Covered Entity or Not Charles, The definition of a "covered entity" entails more than just filing electronic claims. There are several "covered transactions" and if you conduct any of them electronically then you are a CE and must comply with HIPAA. For a complete list of "covered transactions" refer to the Transaction and Code Set Standards. I would also note that the definition of conducting a transaction "electronically" is often debated. I know HHS has indicated in the preamble to the Privacy Rule that a fax does not count as electronic transmission. Noel Chang -- Open WebMail Project (http://openwebmail.org) -- Original Message --- From: [EMAIL PROTECTED] To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Fri, 31 Jan 2003 10:57:47 -0500 Subject: Covered Entity or Not > At a meeting yesterday of our parent organization's privacy officers > we had a discussion I'd appreciate some feedback on. One of the > organizations is a long-term care/retirement facility that indicated > they do not "bill" electronically. Therefore they are not a covered > entity. However, after further discussion they indicated they do in > fact send via fax and/or email individual identifiable health > information to other covered entities (ie hospitals, referral > agencies, and referring agencies). Some contended because they did > not use EDI, they didn't really need to comply, others indicated > they were because they do send PHI via electronic media. > > Can anyone provide an insight? > > Thanks. > > Charles. > > > > Charles R. Carnahan, M.Div., M.B.A. > > Chief Operating Officer > > CAB Health and Recovery Services, Inc. > > 111 Middleton Road > > Danvers, MA 01923 > > Phone: 978-739-7600 > > FAX: 978-750-3620 > > www.cabhealth.org > > * > > --- > The WEDI SNIP listserv to which you are subscribed is not moderated. > The discussions on this listserv therefore represent the views of > the individual participants, and do not necessarily represent the > views of the WEDI Board of Directors nor WEDI SNIP. If you wish to > receive an official opinion, post your question to the WEDI SNIP > Issues Database at http://snip.wedi.org/tracking/. These listservs > should not be used for commercial marketing purposes or discussion > of specific vendor products and services. They also are not > intended to be used as a forum for personal disagreements or > unprofessional communication at any time. > > You are currently subscribed to wedi-privacy as: > [EMAIL PROTECTED] To unsubscribe from this list, go to the > Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a > blank email to [EMAIL PROTECTED] If you > need to unsubscribe but your current email address is not the same > as the address subscribed to the list, please use the > Subscribe/Unsubscribe form at http://subscribe.wedi.org --- End of Original Message --- --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessaril
Re: Covered Entity or Not
Charles, The definition of a "covered entity" entails more than just filing electronic claims. There are several "covered transactions" and if you conduct any of them electronically then you are a CE and must comply with HIPAA. For a complete list of "covered transactions" refer to the Transaction and Code Set Standards. I would also note that the definition of conducting a transaction "electronically" is often debated. I know HHS has indicated in the preamble to the Privacy Rule that a fax does not count as electronic transmission. Noel Chang -- Open WebMail Project (http://openwebmail.org) -- Original Message --- From: [EMAIL PROTECTED] To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Fri, 31 Jan 2003 10:57:47 -0500 Subject: Covered Entity or Not > At a meeting yesterday of our parent organization's privacy officers > we had a discussion I'd appreciate some feedback on. One of the > organizations is a long-term care/retirement facility that indicated > they do not "bill" electronically. Therefore they are not a covered > entity. However, after further discussion they indicated they do in > fact send via fax and/or email individual identifiable health > information to other covered entities (ie hospitals, referral > agencies, and referring agencies). Some contended because they did > not use EDI, they didn't really need to comply, others indicated > they were because they do send PHI via electronic media. > > Can anyone provide an insight? > > Thanks. > > Charles. > > > > Charles R. Carnahan, M.Div., M.B.A. > > Chief Operating Officer > > CAB Health and Recovery Services, Inc. > > 111 Middleton Road > > Danvers, MA 01923 > > Phone: 978-739-7600 > > FAX: 978-750-3620 > > www.cabhealth.org > > * > > --- > The WEDI SNIP listserv to which you are subscribed is not moderated. > The discussions on this listserv therefore represent the views of > the individual participants, and do not necessarily represent the > views of the WEDI Board of Directors nor WEDI SNIP. If you wish to > receive an official opinion, post your question to the WEDI SNIP > Issues Database at http://snip.wedi.org/tracking/. These listservs > should not be used for commercial marketing purposes or discussion > of specific vendor products and services. They also are not > intended to be used as a forum for personal disagreements or > unprofessional communication at any time. > > You are currently subscribed to wedi-privacy as: > [EMAIL PROTECTED] To unsubscribe from this list, go to the > Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a > blank email to [EMAIL PROTECTED] If you > need to unsubscribe but your current email address is not the same > as the address subscribed to the list, please use the > Subscribe/Unsubscribe form at http://subscribe.wedi.org --- End of Original Message --- --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
Re: Covered Entity or Not
The answer is in the "covered entity" definition found at 160.103 "Covered entity means...A health care provider who transmits any health information in electronic form in connection with a transaction covered by this subchapter" So the transmission must be in connection with a standard transaction (e.g. claims, eligibility, encounter, claims status, referal certification and authorization, etc.) Regards, lhc Leah Hole-Curry, JD FOX Systems, Inc. 602.708.1045 Information transmitted is confidential and may be proprietary to FOX Systems, Inc. It is intended only for the person or entity to which it is addressed. Anyone else is prohibited from disclosing, copying, or disseminating the contents or attachments. If you receive this in error, please notify sender immediately, or us at www.foxsys.com and delete from your system. >>> <[EMAIL PROTECTED]> 01/31/03 08:59 AM >>> At a meeting yesterday of our parent organization's privacy officers we had a discussion I'd appreciate some feedback on. One of the organizations is a long-term care/retirement facility that indicated they do not "bill" electronically. Therefore they are not a covered entity. However, after further discussion they indicated they do in fact send via fax and/or email individual identifiable health information to other covered entities (ie hospitals, referral agencies, and referring agencies). Some contended because they did not use EDI, they didn't really need to comply, others indicated they were because they do send PHI via electronic media. Can anyone provide an insight? Thanks. Charles. Charles R. Carnahan, M.Div., M.B.A. Chief Operating Officer CAB Health and Recovery Services, Inc. 111 Middleton Road Danvers, MA 01923 Phone: 978-739-7600 FAX: 978-750-3620 www.cabhealth.org * --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
RE: Covered Entity or Not
A provider is a covered entity under HIPAA if the provider sends any of the HIPAA mandated transactions electronically. Once a provider sends one of these transactions, he/she is "in" and must comply with the privacy and security requirements of HIPAA as well as those for the electronic transactions. If a provider does not send any of the HIPAA electronic transactions (using EDI or via a direct data entry system OR through an agent such as a billing service), the provider is not a HIPAA covered entity and is not required to abide by the privacy standards. Use of a fax to send information does not qualify as using a HIPAA electronic transaction. Strange as it may seem, such a provider can send protected health information by fax or e-mail (shudder) and the HIPAA cops can't get him. However, who is to say what vulnerability there might be from litigation if such a provider does not observe the "standard of care" that HIPAA privacy regulations have established for the healthcare industry? Joan Joan Boyle HIPAA Compliance Manager The TriZetto Group, Inc. Voice: 970-627-1675 Fax: 970-627-1677 [EMAIL PROTECTED] *** Confidentiality Notice *** This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message and are hereby notified that any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Friday, January 31, 2003 8:58 AM To: WEDI SNIP Privacy Workgroup List Subject: Covered Entity or Not At a meeting yesterday of our parent organization's privacy officers we had a discussion I'd appreciate some feedback on. One of the organizations is a long-term care/retirement facility that indicated they do not "bill" electronically. Therefore they are not a covered entity. However, after further discussion they indicated they do in fact send via fax and/or email individual identifiable health information to other covered entities (ie hospitals, referral agencies, and referring agencies). Some contended because they did not use EDI, they didn't really need to comply, others indicated they were because they do send PHI via electronic media. Can anyone provide an insight? Thanks. Charles. Charles R. Carnahan, M.Div., M.B.A. Chief Operating Officer CAB Health and Recovery Services, Inc. 111 Middleton Road Danvers, MA 01923 Phone: 978-739-7600 FAX: 978-750-3620 www.cabhealth.org * --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
Covered Entity or Not
At a meeting yesterday of our parent organization's privacy officers we had a discussion I'd appreciate some feedback on. One of the organizations is a long-term care/retirement facility that indicated they do not "bill" electronically. Therefore they are not a covered entity. However, after further discussion they indicated they do in fact send via fax and/or email individual identifiable health information to other covered entities (ie hospitals, referral agencies, and referring agencies). Some contended because they did not use EDI, they didn't really need to comply, others indicated they were because they do send PHI via electronic media. Can anyone provide an insight? Thanks. Charles. Charles R. Carnahan, M.Div., M.B.A. Chief Operating Officer CAB Health and Recovery Services, Inc. 111 Middleton Road Danvers, MA 01923 Phone: 978-739-7600 FAX: 978-750-3620 www.cabhealth.org * --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: archive@mail-archive.com To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
