HIPAA Rules Equations Paper Facts Paper Chisel Cosmos Age Paper Digital/ Film
M. A. DePompolo Products Investigations
MEMORANDUM
TO:
Clients
FROM:
Michael DePompolo
DATE:
December 12, 2013
RE:
HIPAA; Incident Scene Covered Parties
_____________________________________________________
Title I of HIPAA protects health insurance coverage for workers and their
families when they change or lose their jobs.
Title II of HIPAA, known as the Administrative Simplification provisions,
requires the establishment of national standards for electronic health care
transactions and national identifiers for providers, health insurance plans, and
employers.
The Administrative Simplification
provisions also address the security and privacy of health data which is the
area at issue regarding communications with law enforcement, emergency rescue
and victim transport personnel.
Although other ethical considerations might apply, police officers,
firefighters and first responders that assist at incident scenes are generally not
covered entities under HIPAA. The
reason for this is that law enforcement and rescue personnel at an incident
scene generally do not charge the patient for medical services rendered.
HIPAA applies when a patient is charged for medical services(1)
by a health care provider.
Ambulance attendants and medics involved in transporting an individual to a
medical facility are covered entities.
The function of transport generates a fee for a covered transaction(2)
with the victim or their insurance.
Therefore, the medical services ambulance personnel perform from preparing a
victim at a scene for transport through delivery to a medical facility is
protected data under the Administrative Simplification provisions.
A gray area would be for instance, an ambulance crew that is short-handed
and tells a fire department first responder at the scene to “jump in” the back
of the ambulance to assist in transport.
That fire department first responder probably does not generate a third
party financial transaction with the patient.
Nevertheless, this would be an example of a situation where an informal
interview would not be recommended with that first responder without a signed
medical authorization releasing that person to address medical issues.
From
http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/downloads/coveredentitycharts.pdf
the two principle questions to determine covered entities are:
Does the person, business, or agency
furnish, bill or receive payment for health care in the normal course of
business?
AND
Does the person, business or agency transmit (send) any covered transactions
electronically?
(1.)
Health care
means: care, services, or supplies related to the health of an individual. It
includes, but is not limited to, the following: (1) Preventive, diagnostic,
rehabilitative, maintenance, or palliative care, and counseling, service,
assessment, or procedure with respect to the physical or mental condition, or
functional status, of an individual or that affects the structure or function of
the body; and (2) Sale or dispensing of a drug, device, equipment, or other item
in accordance with a prescription. See 45 C.F.R.160.103.
Medical care
means: amounts paid for: (A) diagnosis, cure, mitigation, treatment or
prevention of disease, or amounts paid for the purpose of affecting any
structure or function of the body; (B) amounts paid for transportation primarily
for and essential to medical care referred to in (A); and (C) amounts paid for
insurance covering medical care referred to in (A) and (B). See 42 U.S.C.
300gg-91(a) (2).
(2.) Covered transactions
are transactions for which the Secretary has adopted standards; the standards
are at 45 C.F.R. Part 162. If a
healthcare provider uses another entity (such as a clearinghouse) to conduct
covered transactions in electronic form on its behalf, the health care provider
is considered to be conducting the transaction in electronic form.
A transaction is a covered transaction if it meets the regulatory
definition for the type of transaction.
These definitions for each type of covered transaction are provided
below:
45 C.F.R.162.1101: Health care claims or equivalent encounter information transaction is either of the following:
(a) A request to obtain payment, and necessary accompanying information, from a
health care provider to a health plan, for health care.
(b) If there is no direct claim, because the reimbursement contract is based on
a mechanism other than charges or reimbursement rates for specific services, the
transaction is the transmission of encounter information for the purpose of
reporting health care.
45 C.F.R.162.1201: The eligibility for a health plan transaction is the
transmission of either of the following:
(a) An inquiry from a health care provider to a health plan or from one health
plan to another health plan, to obtain any of the following information about a
benefit plan for an enrollee:
(1) Eligibility to receive health care under the health plan.
(2) Coverage of health care under the health plan.
(3) Benefits associated with the benefit plan.
(b) A response from a health plan to a health care provider's (or another health
plan's) inquiry described in paragraph (a) of this section.
45 C.F.R.162.1301: The referral certification and authorization transaction is any of the following transmissions:
(a) A request for the review of health care to obtain an authorization for the
health care.
(b) A request to obtain authorization for referring an individual to another
health care provider.
(c) A response to a request described in paragraph (a) or paragraph (b) of this section.
45 C.F.R.162.1401: A health care claim status transaction is the transmission of either of the following:
(a) An inquiry to determine the status of a health care claim.
(b) A response about the status of a health care claim.
45 C.F.R.162.1501: The enrollment and disenrollment in a health plan transaction
is the transmission of subscriber enrollment information to a health
plan to establish or terminate insurance coverage.
45 C.F.R.162.1601: The health care payment and remittance advice transaction is
the transmission of either of the following for health care:
(a) The transmission of any of the following from a health plan to a health care
provider's financial institution:
(1) Payment.
(2) Information about the transfer of funds.
(3) Payment processing information.
(b) The transmission of either of the following from a health plan to a health care provider:
(1) Explanation of benefits.
(2) Remittance advice.
45 C.F.R.162.1701: The health plan premium payment transaction is the
transmission of any of the following from the entity that is arranging for the
provision of health care or is providing health care coverage payments for an
individual to a health plan:
(a) Payment.
(b) Information about the transfer of funds.
(c) Detailed remittance information about individuals for whom premiums are
being paid.
(d) Payment processing information to transmit health care premium payments including any of the following:
(1) Payroll deductions.
(2) Other group premium payments.
(3) Associated group premium payment information.
45 C.F.R.162.1801: The coordination of benefits transaction is the transmission
from any entity to a health plan for the purpose of determining the relative
payment responsibilities of the health plan, of either of the following for
health care:
(a) Claims.
(b) Payment information.
In electronic form
means: using electronic media, electronic storage media including memory devices
in computers (hard drives) and any removable/transportable digital memory
medium, such as magnetic tape or disk, optical disk, or digital memory card; or
transmission media used to exchange information already in electronic storage
media. Transmission media include, for example, the internet (wide-open),
extranet (using internet technology to link a business with information
accessible only to collaborating parties), leased lines, dial-up lines, private
networks, and the physical movement of removable/transportable electronic
storage media. Certain transmissions, including of paper, via facsimile, and of
voice, via telephone, are not considered to be transmissions via electronic
media, because the information being exchanged did not exist in electronic form
before the transmission.