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Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Federal law designed to limit exclusions for preexisting conditions, prohibit discrimination against employees and dependents based on their health status, guarantee that health insurance is available to small employers, and guarantee renewability of insurance to all employers regardless of size. However, people must go through the Consolidated Omnibus Budget Reconciliation Act program before using HIPAA. HIPAA allows portability in that it provides continuing insurance coverage when a person changes employment. It also simplifies administrative aspects of electronic health care transactions; mandates standard transaction code sets used by providers, plans, payers, and employers; and orders security, privacy, and confidentiality of patients’ health information via electronic transmission. HIPAA requires use of national identification systems for health care patients, providers, payers or plans, and employers. This act is also known as K2, Kennedy-Kasselbaum Bill, Kennedy-Kassenbaum Bill , and Public law 104-191 .

health insurance prospective payment system (HIPPS)

Code system for procedures that is used when billing Medicare patients in skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and swing bed facilities in rural hospitals. HIPPS codes are alphanumerical codes of five digits: The first three are derived from the resource utilization group (RUG), and the last two represent a modifier code for the specific assessment. This code is put in Form Locator 44 on the UB-04 Medicare claim form. Any patient coded in one of the top 26 RUGs is a skilled patient.

Health Insurance Regulations 2013

In February 2013 IRDA passed comprehensive Regulations governing Health Business in India which as far as customer is concerned, include (a) Renewal of Policies (b) Free look period (c) Cost of pre-insurance health checkup (d) Cumulative bonus € Option to migrate (f) Disclosures and declaration (g) Standard definitions and nomenclature (h) Standard excluded items (i) Provisions relating to senior citizens (j) Upper limit and maximum cover (k) Settlement/rejection of claims (l) Administration of health policies (m) Payment of claim and (n) Portability of cover etc.

Health Insurance Regulations 2016

Recently, following a number of representations made by various stakeholders (including Insurers) on a multitude of issues as well as to update the existing framework, the IRDAI, by way of a notification of 18th July 2016, issued the IRDAI (Health Insurance) Regulations 2016 (Health Regulations 2016) replacing the Health Regulations 2013. The IRDAI also replaced the Standardization Guidelines 2013 with the Guidelines on Standardization in Health Insurance of 29th July 2016 (Standardization Guidelines 2016) and the Guidelines on Product Filing in Health Insurance Business of 29th July 2016 (Product Filing Guidelines). Health Insurance Regulations 2016, Registration and Scope of Health Insurance Business : As per Section 3 of the Health Insurance Regulations 2016: Health Insurance products may be offered only by entities with a valid registration granted to carry on Life Insurance or General Insurance or Health Insurance Business under the Insurance Regulatory and Development Authority (Registration of Indian Insurance Companies) Regulations 2000 as amended from time to time.Life Insurers may offer long term Individual Health Insurance products i.e., for term of 5 years or more, but the premium for such products shall remain unchanged for at least a period of every block of three years, thereafter the premium may be reviewed and modified as necessary. Provided that a life insurer may not offer indemnity based products either Individual or Group. All existing indemnity based products offered by life insurers shall be withdrawn as specified under these Regulations. Provided also that no single premium health insurance product shall be offered under Unit Linked platform.General Insurers and Health Insurers may offer individual health products with a minimum tenure of one year and a maximum tenure of three years, provided that the premium remains unchanged for the tenure.Group Health Policies may be offered by any insurer for a term of one year except credit linked products where the term can be extended up to the loan period not exceeding five years Provided General Insurers and Health Insurers may also offer Credit Linked Group Personal Accident policies for a term extended up to the loan period not exceeding five years.Provided further, notwithstanding the provisions of Regulation 4 (b) of these Regulations, Life Insurers may offer Group Health Insurance Policies as specified in Regulation (3) (d).Group Personal Accident Policies may be offered by General Insurers and Health insurers with term less than one year also to provide coverage to specific events. Other Insurance Products offering Travel Cover and Individual Personal Accident Cover may also be offered for a period less than one year.Overseas or Domestic Travel Insurance policies may only be offered by General Insurers and Health Insurers , either as a standalone product or as an add-on cover to a health or personal accident policy.Health Insurance, Restrictions on Life Insurers offering Health Insurance Policies : Life Insurers are prohibited from offering indemnity based health insurance products either as individual or group policies. Consequently, all such existing indemnity based products offered by Life Insurers are now required to be withdrawn in accordance with the prescribed procedure.

health insuring organization (HIO)

Entity that provides for or arranges for the provision of care and contracts on a prepaid capitated risk basis to provide a comprehensive set of services. This may involve state or federal programs such as Medicaid or Medicare beneficiaries. HIOs contract with providers on a discounted fee-for-service or a capitated basis to provide medical services.

Health IT Certification

Provides professional training and certification for those responsible for planning, selecting, implementing, and managing electronic health records (EHRs) and other health information technology (HIT). See Certified Professional in Electronic Health Records (CPEHR) and Certified Professional in Health Information Technology (CPHIT) . Website: www.HealthITCertification.com

Health Level Seven (HL7)

Standard protocols and encoding rules published for developers to apply in the health industry. These were created by the Accredited Standards Committee X12 (ASC X12), a committee formed by American National Standards Institute (ANSI). HL7 sets some of the electronic standards for exchange of clinical and administrative information in health care applications (see Box H-1 ).Box H-1HEALTH LEVEL SEVEN FORMAT OF DATE AND TIME OF BIRTHTo determine the date and time of a patient’s birth date (e.g., for a neonate, for whom the age in hours might be relevant), the time of the birth, using military time, can be recorded with the birth date. From this, the age can be generated from the date of birth (DOB). Baby Jane was born on March 24, 2007, at 8:26 am .When the required HL7 format is YYYY MMDDHHMM, Baby Jane’s date and time of birth will be entered for transmission as: 200703240826YYYYMMDDHHMM200703240826YearMonthDayHourMinute